Care Home: Mill Green

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What the care home does well The service at Mill Green is relatively small and intimate and is based on what people living in the home want and need. The home is comfortable and welcoming. Services that provide social care must be sensitive to people of different cultures, age, gender, faith, disability and sexuality. Throughout the service, there was evidence of a good awareness and understanding of equality and diversity issues, which translated into positive outcomes for residents. Residents are supported to be as independent as they can and to keep in touch with their family and friends. They have access to a range of meaningful daily activities. Staff evidenced a good understanding of resident`s individual needs and respected their choices and decisions. Staff was clearly able to respond well to residents specific communication needs and residents were observed to be relaxed and happy in their company. What has improved since the last inspection? A number of improvements have been made to the home`s environment including the installation of a new kitchen. The residents dining area has been redecorated and access improved.Two residents bedrooms have been re decorated and refurbished. The front garden has been tidied and the area turfed. The home`s utility area has been updated with a new floor covering. The entrance has been moved to aid better infection control measures in the home. The manager has carried out a risk assessment in relation to the installation of radiator covers. Some work to cover hot surfaces in the home has already been completed, the remaining six radiators, which require covering to better protect residents, continues. Recruitment procedures have improved, the process now better involves the manager, other staff members and residents. The Provider Company is in the process of reviewing and updating policies and procedures. Procedures in relation to safeguarding vulnerable adults have already been revised to meet good practice demands and updated legislation. Staff training reflects local authority guidelines to ensure the protection of residents. Since the appointment of the new manager, access to training and refresher training for staff has been reorganised and improved. Staff evidenced confidence in her leadership abilities and morale was seen to be high, which translates into positive outcomes for residents. What the care home could do better: All future pre admission assessment documentation must be available for inspection to evidence the home`s good practice. Residents are largely protected by the homes procedures for managing medication administration however, some minor improvements to current facilities and adjustments to procedures would further benefit residents and ensure they are not placed at any risk. Residents would benefit from plans which provide for further refurbishment and redecoration of the premises in some areas and the protection of all hot surfaces. Residents benefit from having a new and suitably qualified manager whose aim it is to consistently improve and develop the services at Mill Green. They would benefit further from the individual proving fitness for registration with the Commission and being enabled to provide a consistent presence at the home. CARE HOME ADULTS 18-65 Mill Green Mill Green Mill Lane Felbridge East Grinstead West Sussex RH19 2PF Lead Inspector Marion Weller Key Unannounced Inspection 14th November 2007 10:30 Mill Green DS0000013721.V353733.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 Mill Green DS0000013721.V353733.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. Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mill Green Address 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) Mill Green Mill Lane Felbridge East Grinstead West Sussex RH19 2PF 01342 326105 N/A N/A Ashcroft Care Services Ltd Post Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th March 2007 Brief Description of the Service: Mill Green is a large detached house located in a quiet residential area in the village of Felbridge, East Grinstead. The home is registered to provide personal care for six younger adults with learning disabilities who may also have behaviour, which challenges. Ashcroft Care Services Ltd owns the home. The accommodation comprises of six single bedrooms, two sitting rooms, a kitchen/dining room, a utility room, toilets, and two bathrooms. The home has a large enclosed rear garden for service users to enjoy, and there is ample parking at the front of the premises. East Grinstead town centre is a short distance by car, and provides a good range of shopping and leisure facilities. The fees range from £1249 per week to £1480 per week according to assessed personal need. Please contact the manager for further details. Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Marion Weller, Regulatory Inspector, who visited Mill Green on Wednesday 14th November 2007 from 10.30 a.m. until 3:15 pm. During that time, the Inspector spoke with the manager and some staff. Some judgements about the quality of life within the home were taken from observations and conversation. Some records and documents were looked at and in addition, a full tour of the premises was undertaken. The home’s Annual Quality Assurance Assessment (AQAA) was sent to the commission prior to the inspection and was also used to further inform the report. Due to the communication difficulties experienced by residents, direct views about their care could not be obtained. Therefore, observations of interactions and resident responses through non-verbal communication have been reflected in this report where it is possible to do so. Staff gave their full co-operation throughout the inspection. What the service does well: What has improved since the last inspection? A number of improvements have been made to the home’s environment including the installation of a new kitchen. The residents dining area has been redecorated and access improved. Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 6 Two residents bedrooms have been re decorated and refurbished. The front garden has been tidied and the area turfed. The home’s utility area has been updated with a new floor covering. The entrance has been moved to aid better infection control measures in the home. The manager has carried out a risk assessment in relation to the installation of radiator covers. Some work to cover hot surfaces in the home has already been completed, the remaining six radiators, which require covering to better protect residents, continues. Recruitment procedures have improved, the process now better involves the manager, other staff members and residents. The Provider Company is in the process of reviewing and updating policies and procedures. Procedures in relation to safeguarding vulnerable adults have already been revised to meet good practice demands and updated legislation. Staff training reflects local authority guidelines to ensure the protection of residents. Since the appointment of the new manager, access to training and refresher training for staff has been reorganised and improved. Staff evidenced confidence in her leadership abilities and morale was seen to be high, which translates into positive outcomes for residents. What they could do better: All future pre admission assessment documentation must be available for inspection to evidence the home’s good practice. Residents are largely protected by the homes procedures for managing medication administration however, some minor improvements to current facilities and adjustments to procedures would further benefit residents and ensure they are not placed at any risk. Residents would benefit from plans which provide for further refurbishment and redecoration of the premises in some areas and the protection of all hot surfaces. Residents benefit from having a new and suitably qualified manager whose aim it is to consistently improve and develop the services at Mill Green. They would benefit further from the individual proving fitness for registration with the Commission and being enabled to provide a consistent presence at the home. Mill Green DS0000013721.V353733.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. Mill Green DS0000013721.V353733.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 Mill Green DS0000013721.V353733.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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The personalised needs assessment means peoples diverse needs are identified and planned before they move to the home. Pre admission assessment documentation must be available to evidence the home’s good practice. EVIDENCE: There have been no admissions to the home since the Commissions previous visit in March 2007. It was explained that initial referrals for admission to the home are received at the company’s head office. The process for assessing the suitability of prospective residents is then carried out with the home’s manager having the opportunity to participate. The home currently has one vacancy and they have received two requests for admission. The manager was able to go through the admission policy and procedure they follow when a vacancy occurs. The explanation included an assurance that a prospective residents aspirations and needs would be comprehensively assessed prior to admission and their compatibility with existing residents firmly established. The process-involved information Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 10 gathering from all stakeholders such as parents, representatives, care managers, and any specialist health professionals previously involved in the individuals care. A comprehensive history is obtained to help the decision making process. The provider also routinely involves their clinical team to further inform the assessment process. The manager’s explanation clearly met good practice guidelines and the process assures peoples diverse needs are identified and planned before they move to the home. It was previously recommended that copies of pre- admission assessments be maintained in the home for inspection purposes to evidence good practice. The manager stated their intention that paperwork for all future new admissions would be retained on file. This matter will be revisited on subsequent inspections. In the interim, the good practice recommendation will be included in this report. Mill Green DS0000013721.V353733.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): 679 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents have individual care and support plans that ensure their needs are identified and met. They are supported to take assessed risks as part of an independent lifestyle and to make decisions in their lives wherever possible. EVIDENCE: Residents had individual care and support plans based on their assessment of need and included star profiles. Three care plans were inspected in detail. Individual plans clearly identified what care and support was to be given and how. Care Plans evidenced regular review dates and where required they had been developed in conjunction with other relevant health care professionals, relatives and/or representsives. There was a requirement issued in the Commissions last report for the manager to ensure that service users and/or their representatives agreed and signed their individual care plans. On this visit, the necessary action was seen to have been taken. Care plans inspected Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 12 had been signed either by relatives or representatives. The requirement is met and will be removed from this report. There is a key worker system in place and staff spoken with had a good knowledge and awareness of peoples needs. Staff confirmed that they are regularly involved in care plan reviews. The company is introducing person centred plans in the near future. It was observed that service users had individual skill building programmes in place, which included household skills. Residents are supported to take reasonable risks to allow them to participate in the activities they wish to. All risks had been appropriately assessed and kept under review. A previous requirement was issued in the Commissions last report to ensure that individual risk plans are reviewed and updated to ensure the health, safety and welfare of people who live in the home. This has now been met and will be removed from this report. Residents had communication passports and health action plans implemented in addition to existing care/ support plans. Mill Green DS0000013721.V353733.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 15 16 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents have opportunities for personal development and take part in appropriate activities. They are very much part of the local community and maintain contact with family members. Residents are offered a healthy nutritious diet and enjoy their meals. EVIDENCE: There are communication passports within residents care /support plans which promote independence and life skills, leisure activities, daily routines and identify any restrictions placed upon them or areas of risk. Risk assessments are undertaken, recorded and regularly reviewed. Residents are supported to Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 14 take reasonable risks to allow them to participate in the activities they wish to. Residents participate in activities mainly on an individual basis due to their differing likes and dislikes. Each individual has a structured activities programme in place and activities are based on individual needs and preferences including swimming, rambling, trampoline, carriage riding, pub visits, gardening club, eating out, drama, arts and craft sessions and the ‘Rights of Way’ project, where a team of interested individuals work with a supervisor to clear footpaths, help build new gates and stiles on behalf of the local council. The home has their own transport, which provides residents with the opportunity to go out on day trips, and some go away on holidays. Arrangements were being during the site visit for one resident to go away for a long weekend in self-catering accommodation with the support of two staff. One individual likes church music and attends church every Sunday. Residents are supported to use local facilities including shops and restaurants. They have built up neighbourly relationships within the local community, as a result of frequent access to the services and facilities nearby. Most residents maintain contact with their families on a regular basis, which includes them making visits to the home and also involves them enjoying activities together outside the home. One Individual goes swimming with a relative and is assisted by a member of staff. Members of the local church congregation visit another individual. The rules of the home respects resident’s rights to privacy, all bedrooms doors are fitted with locking devises. No residents currently retain keys to their rooms. The manager stated the intention of recording the rationale for residents not holding keys in their plan of care. Residents are encouraged to be involved in the day to day running of the home as far as they can be and they have access to all areas of the home. Individual care and support plans cover eating, drinking and meal times and provides details of the support needed and particular preferences. Residents have a nutritional assessment in place. The nutritional assessments enable staff to monitor and record significant signs of loss or weight gain and the document demonstrates the actions which need to be taken by the home in either case. Varied, balanced and nutritious menus were in place and are planned on a weekly basis. Meals are based on individual preferences or health needs and where alternative meals are provided these are recorded on the menu. Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 15 Mill Green DS0000013721.V353733.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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer and they can be confident that their health care needs will be met in full. Residents are largely well protected by the homes procedures for managing medication administration. Some minor improvements to the home’s current facilities and adjustments to procedures would further benefit residents and ensure they are not placed at any risk. EVIDENCE: Resdients have relevant care and support plans for their health and hygiene. needs. Health Support is provided to the service users via their GP. This includes access to annual health checks. Health and support needs are also assessed and reviewed by the individuals care manager every six months as part of their care plan review. Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 17 The manager sated that the local surgery offers significant support to people who live in the home. Health care staff are well aware of their particualr needs, especially as resdients have limited verbal communication. For instance, they ensure medication regimes are monitored more intensly than for people who have a more easliy understood communication styles. Personal care needs are supported in private, and gender support plans are in place. Designated key workers and co key workers are allocated to each ressdients who monitor such areas as medical appointments, therapies, chirpody, weight / nutiritionn, sleep charts, behaviour patterns and emotional support needs. The home’s medication administration systems and records were inspected. The home has a medication policy and procedure document for staff to follow. Each resdient has a medication administrartion profile in their MAR chart. No resident currently self medicates. All staff are adequatly trained. Evidence was seen that staff receive epilepsy and medication training with refreshers every three years, and rectal diazepam training annually. The home uses a Monitored Dosage System (MDS) supplied from a local pharmacy. The Pharmacist visits and audits procedures in the home six monthly. Stock control is monitored in the home weekly. There were no obvious gaps in records of medication administration. Some handwritten transcriptions in MAR charts however had not be dated by the person making the entry which would make auditing medication difficult, should it be necessary. The home could not evidence records of ambient room temperatures for medicine storage and neither do they have a dedicated lockable drugs fridge for cold storage of medicines. They must keep regular temperature records and evidence that they have risk assessed the decision not to provide dedicated equipment based on an assessment of vulnerability and risk to residents. The signatory list for medication administrators was not current and illustrated staff names that had been crossed through. The list should be revised and be kept up to date. Minor improvements to medication administration in the home were discussed with the manager who stated her intention to resolve shortfalls immediately to protect residents from any potential for harm and to evidence good practice. This will be recommended in this report. Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in the home have their views understood and acted upon. They are protected from abuse, neglect and self-harm. EVIDENCE: The CSCI has not received any complaints regarding the service at Mill Green. The home has a clear complaints procedure which they ensure people have ready access to. Residents can be provided with a pictorial format to ensure they understand they can make their dissatisfactions known and these will be understood. The majority of residents have difficulty with communication and therefore staff rely on their skills of observation and monitoring in relation to their general health and known behaviour patterns to inform them of levels of satisfaction or unhappiness. A copy of the homes complaints procedure is displayed in the entrance hall of the home for relatives/ representatives and other visitors to access. It would be enhanced by the addition of relevant contact details for the Local Social Services Department. The manager confirmed that there have been no complaints raised with them in the last 12 months. The safeguarding adults policy was seen, this is in line with the local authorities procedures. There has been no adult protection alerts raised in connection with the home since the last site visit. Records evidence that all levels of staff in the home have received training in safeguarding adult’s Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 19 procedures. Staff spoken with were clear in their responses as to the action that they would take if they ever witnessed any form of abuse. Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a clean and comfortable environment where they are able to access all communal areas. They would benefit further from the modernisation and redecoration of the premises in some areas and the protection of all hot surfaces in the home. EVIDENCE: A number of significant improvements have been made to the home’s environment since the last CSCI site visit in March 2007. A new and modern kitchen and floor surface has been installed. The residents dining area, previously rather cramped, has been redecorated with improved space and access provided by the revised lay out of the kitchen. Two residents bedrooms have been re decorated and refurbished. The front garden has been tidied and the area turfed. A jet wash machine has been purchased to clean and help maintain all outside areas. The home’s utility area has been updated with a new floor covering and the entrance moved to the corridor to aid better Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 21 infection control measures in the home. A contractor visits regularly to professionally clean the home’s carpets. The manager has carried out a risk assessment in relation to the installation of radiator covers. Some work to cover hot surfaces in the home has already been completed, the remaining six radiators, which require covering to better protect residents, is said by the manager to be planned. Some areas in the house were identified and discussed with the manager that would benefit from further redecoration and modernisation including window frames, bathrooms, bathroom floors and some residents bedrooms. There are currently steps leading to the back garden. This could be improved to allow for better and more permanent disabled access. The home does have portable ramps to support residents with mobility problems to get in and out of the house. The inspector was informed that the provider has a planned programme of refurbishment in place. This was not available to view in the home. The manager said that quotes were being gathered to replace aged lounge furniture. Residents had already visited local shops to make their preferences known. The premises were observed to be clean, hygienic and odour free. Separate laundry facilities are provided and hand-washing equipment was available in the toilets and the bathrooms. Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents benefit from a competent and dedicated staff team who understand their roles and responsibilities and know what is expected of them. They are further protected by the home’s robust recruitment practices. EVIDENCE: Staff duty rotas were examined which evidenced the deployment of three staff during the day, with another person working from nine am, until five pm. At night time one waking and one sleep in member of staff is provided. All staff have a job description, and where it is relevant, agreed guidelines are in place for areas of additional responsibility, such as key working. Each resident has a key-worker who is responsible for ensuring appointments are made and kept with health services and significant others, including care managers for reviews, monthly evaluation of care/ support plans and purchasing of clothes etc. Staff spoken with were able to evidence a good awareness of residents needs and preferences. Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 23 Staff are supported to complete National Vocational Qualifications. Training records were inspected which confirmed staff had received up to date mandatory training in safeguarding adults, moving and handling, food hygiene, first aid and health and safety. A training schedule is maintained which illustrates when staff are due to attend their next update. Records and certificates in staff files verified attendance at specialist training in autism, challenging behaviour and epilepsy, which supports the current needs of service users. Staff had also received ‘in house’ training in equality and diversity recently. Two members of staff were due to undertake Makaton training to assist with resident’s communication needs. There is a revised induction programme for new staff that meets ‘skills for care’ standards. The provider has appointed a new Training Manager who, according to the home’s AQAA, was responsible for the formulation of the induction programme and for accessing the best quality training providers for staff. Staff receives regular planned formal supervision. Records of these sessions were viewed in staff files and evidenced that staff training needs are routinely discussed and assessed. Staff files inspected indicated residents were being protected through the use of robust recruitment procedures. Staff were only employed after necessary references and checks had been obtained, and these were found to be satisfactory. Revised recruitment processes give applicants the opportunity to visit the home to meet and interact with residents and staff so the manager can access them for suitability, personality and compatibility. Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents benefit from having a person in charge that provides clear leadership, is qualified and competent and whose aim is to consistently improve and develop the service and outcomes for residents. They would benefit further from the individual proving fitness for registration with the Commission and being enabled to provide a consistent presence at the home. EVIDENCE: There have been a number of changes in the management of the home and the service has been through a fairly unsettled period. A new manager took up post at the beginning of 2007. She currently divides her time between this and another home owned by the same provider. This is not the best arrangement for residents in either home and should be seriously reconsidered by the Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 25 provider. Mill Green accommodates up to six highly dependent residents who require a fairly consistent management presence to promote and ensure their welfare and to support staff. The manager stated that she is hopeful that the situation that requires her to spend time away from Mill Green is now drawing to a satisfactory conclusion. The manager is confident in her practice and has considerable experience of working with people learning disabilities. She already holds the Registered Managers Award, NVQ 4 in Care and the A1 NVQ Assessor Award. At the previous CSCI inspection in March 2007, she stated she was in the process of making an application to the Commission for registration. To date no application has been received. The manager is urged to apply for registration to both confirm her fitness and to evidence her responsibility for service outcomes. Staff spoken with were very positive about the changes the new manager has brought to the home. Comments included, “I was prepared to leave, but she has made such a difference” and “Mill Green is a pleasant and stable place now” The Provider carries out monthly quality visits and copies of completed reports were available for viewing. These were observed to be detailed. The Provider regularly carries out consultation with resident’s relatives/representatives and other stakeholders in the service. The company’s quality assurance manager provides written reports on the outcomes of quality surveys, which have previously been made available to the Commission. Residents are involved as much as possible in the everyday running of the home. A number of the company’s policies and procedures need updating. The manager stated that work to address this is in progress. Equality and Diversity issues have been considered and included in revised and updated documents completed to date, which ensures better outcomes for residents. Water temperature testing is regularly checked and recorded. All substances hazardous to health were stored and locked away appropriately. Accident records and incidents were being maintained appropriately. Maintenance certificates including those for water and gas indicated regular servicing and maintenance of equipment takes place. Since the previous site visit some action has been taken to install radiator covers but this has not been fully completed, however, evidence was provided that a risk assessment had been undertaken and further work was being planned. Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 26 Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA2 YA20 Good Practice Recommendations It is recommended that the home maintain copies of resident’s pre- admission assessments. It is strongly recommended that the manager fulfil her stated intention to address the minor shortfalls in medication administration detailed in the report. It is strongly recommended that the manager apply for registration to the CSCI without further delay and complete the fit person process. 3. YA37 Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Mill Green DS0000013721.V353733.R01.S.doc Version 5.2 Page 30 - 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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