Care Home: Millenia House

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What the care home does well A full and comprehensive assessment of a persons care needs are obtained prior to offering a placement at the home, this ensures that staff have the information to meet those needs. Millenia House provides a satisfactory environment in which to live. There are a selection of communal areas inside the home, this means that people have a choice of place to sit quietly, meet with family and friends or be actively engaged with other people who use the service. The registered manager and staff have a good knowledge of the individual care needs of people living at the home, and provide a good standard of care. What has improved since the last inspection? A two bedroomed semi independent living unit has been registered to provide accommodation for up to two people. It is very close to the main house offering an independent life style with supervision. What the care home could do better: The weekly fees and what is and what is not included in the fees should be detailed in the residents guide. The care plans could be better organised to ensure that care needs information is readily available for reference. No requirements have been made following this inspection. Generally all evidence points to a service that has developed systems to provide good quality outcomes for people living at the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Millenia House 10 Needwood Close Goldthorn Park Wolverhampton West Midlands WV2 4PP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joy Hoelzel     Date: 0 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Millenia House 10 Needwood Close Goldthorn Park Wolverhampton West Midlands WV2 4PP 01902621010 01902621046 milleniahouse@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr George Dixon care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: Flat 6 Needwood Close is registered as an annex to the home. Maximum number of service users at any time is twelve (12) with 2 SU`s in the annex. Date of last inspection Brief description of the care home Millennia House is a care home providing accommodation, personal and nursing care for twelve adults with mental ill health and a learning disability. It is privately owned and managed by George Dixon. The home is located in the Goldthorn area of Wolverhampton, close to shops, pubs and other amenities. The two storey converted building provides a domestic-like setting in which service users have the opportunity to develop everyday living skills such as participating in personal laundry and caring for their own private space. All bedrooms are single occupancy complimented by communal lounge and dining areas. A two bedroomed semi independent living unit has recently been registered to provide accommodation for up to two people. The unit is very close to the main house. Information of the home and the provision of the service Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 0 12 12 Brief description of the care home are available in the brochure and residents guide, both documents are available directly from the home. The residents guide does not include information on the current level of fees for the service. The reader may wish to obtain more up to date information from the care service. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place over five hours on Tuesday 7th October 2008. It was conducted by one Commission for Social Care Inspection regulation inspector with assistance from an expert by experience. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen Care Homes for Adults (18-65 years) Page 6 of 28 included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with the CSCI areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The registered manager completed this document and returned it the commission. Comments from the AQAA are included within this inspection report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. The assessment is always undertaken by a skilled and experienced member of staff, is conducted professionally and sensitively and involves the individual, and their family or representative, where appropriate. Evidence: Information on the service is available from the home in the form of a brochure and residents guide. The documents offer details of all aspects of what can be expected when living at the home. There is a section on fees and what is and what is not included, but it does not specifically state the amount of fees payable. More information is available directly from the home. The case file of the person who recently moved into the home was looked at to see if information had been sought regarding this persons needs prior to moving into the home. Information had been gathered from various outside agencies and an assessment of care needs had been conducted by the home. This gathering of Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: information ensures that the service and the prospective resident can be confident that care needs can be satisfactorily met. Other case files looked at contained similar sources of information and included a full assessment of needs completed by the home prior to offering a placement. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff of the home are strongly committed to supporting all service users including those with limited communication or intellectual skills to make informed decisions, understand the range of options which are available to them and have the right to take responsible risks. Evidence: Each person living at the home has an individual plan of care based on the information gained prior to admission. The plans are discussed with the person and/or their representative on each occasion. Each plan is reviewed at least monthly or when a change of need has been identified. Two case files were selected for inspection, each file containing numerous care plans and risk assessments. It was quite difficult to gain an overview or resumee of a persons needs due to the copious amounts of paperwork. The manager and clinical manager both stated that a more refined care plan is needed. However inspection of these files, observation of working practice and discussions with people living and working at the home suggest that satisfactory care Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: is being delivered. Through out the time of the inspection people were observed to be making decisions of how they were going to spend the day, and had discussions and guidance from staff with making their choice. Most people living at the home have the help from an independent advocate should they need additional support and guidance. The clinical manager discussed the assistance given to some people with financial budgeting and stated that this was a key area where help was required to ensure that a person has sufficient daily cash for their expenses. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are involved in daytime activities of their own choice and according to their individual interests and capability; they have been fully involved in the planning of their lifestyle and quality of life. Evidence: People continue to access the local day centres and social clubs. Recently three people have been supported with inclusion on a local community initiative, with two people continuing to be involved. The manager spoke to us about the frustration of getting young adults on to training courses at college and the difficulties previously experienced. This demonstrated how much the manager cared about the residents and how hard he worked at helping them to get back into the community. Some people stated that there was nothing to do at the home, that they never had Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: any trips or holidays and that it was boring. One person stated that they enjoyed writing poetry but had difficulties with writing it down and previously had help with using a computer, this had been discussed with staff but as yet this had not happened and he was feeling a little frustrated at the delay. All of the residents spoken with enjoyed a lot of freedom and were able to visit their friends and families any time during the day. One resident stated that he could ask to be taken somewhere and a carer would take him, to the shops or for a swim. Most people were arranging what they were going to do during the day and staff were observed to be supporting them with their decisions. General observations and comments from the expert by experience Residents of Millenia House are very much encouraged to look after themselves and to be as independent as possible. But although they were very much left to their own devices, it was very reassuring to see how often the carers checked on them. It is hard to say if the residents are happy at Millenia House, but this is not due to the home itself, more to the issues and illnesses that the residents suffer from. Basically, everyone here did not want to be in residential care but in their own homes and resented being institutionalised. Even though many of the people had negative things to say about the home, everyone had to admit that they had all been in much worse places. I felt very satisfied that the home was providing an excellent mix of protective care and empowered freedom to a very difficult group of people. It was obvious that the manager was totally dedicated to his residents and passionate about helping them progress and develop whilst having to deal with their aggressions and sometimes violent mood. People living at the home have a key to their own bedrooms and have free access to all other areas. Family and friends visit regularly and overnight stays can be arranged. All meals are prepared and served by the catering staff with the main meal being served at lunchtime. Staff stated that meals are plated for each resident even if they are not on the premises, the meal is then available to be warmed up when the person is ready for it, generally though most people eat at lunch time. Two residents complained that they couldnt get a hot drink after 9.00 pm and there was no drink making facilities at all available to them. They felt that from 9.00 at night until the next morning was too long to wait for a hot drink, and they would prefer to have a kettle available to them so that they could make themselves one when the kitchen was closed. The manager stated that hot and cold drinks are available at all times, the resident has to request this from staff, but went on to discuss the plans for a small kitchenette to be available in each of the living units in due course. People living in the annexe have the facility for making drinks but not for the preparation of snacks and meals. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: The Annual Quality Assurance Assessment completed by the manager records Using the person centered plan the residents can express their needs and desires, this includes any social activities, educational, employment etc. This can also include developing and maintaining personal relationships with friends and families. Residents are in contact with their families and friends with the support of staff, again each individual plan is updated as and when required. Overall Millenia House strives to assist residents to integrate into their communities, maximise their independence whenever possible and minimise the risk to self and others. this is balanced between individual choice and their agreement. The AQAA indicates the improvements made during the last twelve months We have continued to develop life skills and experiences through our independent living annex. All residents have bus passes, library cards, sport and leisure cards. A number of our residents are involved in local community projects. And the plan for further improvements We are continuing to develop the home to reflect an independent lifestyle i.e. separate and enhanced bathroom facilities. We will continue to promote independence and choices and activities. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Specialist health, nursing and dietary requirements are recorded in each residents plan, they give a comprehensive overview of their health needs and act as an indicator of change in health requirements. Staff understand the key principles of offering personal support and are responsive to the varied and individual requirements of the residents. Evidence: The care plans document the personal support that each person requires. Most people however require the occasional prompts and only minimal supervision. The expert by experience made the observation, All of the residents I spoke to wore clean clothes and were dressed perfectly well for normal daytime activities in the community. The key worker system ensures that there is a consistency of care and support, general observations confirm that good relationships have been developed and continue between staff and residents. Staff discussed the support offered to residents Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: in relation to their healthcare and stated that people access the various health centres, facilities and specialist services. On admission a risk assessment is completed for the possibility of a person handling their own medication. Currently the registered nurses administer the medications to all residents,no one is self medicating. The staff demonstrated a good knowledge of the procedures for medication and dealing with medicines. The Medication Administration Records (MAR) were looked at and appear to be fully completed, no gaps in the recording sheet were seen in the selection viewed. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and others associated with the home understand how to make a complaint and they are clear of what can be expected to happen if a complaint is made. Evidence: Details of how to make a complaint are displayed at the entrance of the home. The brochure and resident guide given to us during the inspection did not contain this information. The manager stated that some complaints and concerns have been brought to his attention from residents mainly in relation to meals and the behaviour of other residents. The manager confirms that swift action is taken to deal effectively with any problems that are encountered. Three referrals have been made to the safeguarding multi agency team when allegations were made, all three have been satisfactorily concluded. We, the commission, have not received any notifications of concerns or complaints since the last inspection in August 2006. The home has the facility for the safe keeping of small amounts of residents money. Staff explained the process and procedures for dealing with this. Individual recording sheets are maintained, with each transaction being recorded with the full involvement of the resident. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the residents who live there. Evidence: The home is situated in a residential area of Wolverhampton within easy walking distance of the local shops and amentities. It is near the main bus route to the city centre. The home is maintained to an acceptable standard, the communal areas are well furnished and comfortable. The bedrooms are as individual as the occupant. Maintenance and the replacement of the fabric and decoration continues on an as required basis. The main boilers for the heating and hot water are currently being replaced to ensure that the home is maintained at an ambient temperature and that there is sufficient hot water readily available. The manager discussed the future plans for the home with the possibility of the building being divided into two to provide smaller living units. He went on to discuss the programme for upgrading and refurbishing the toilets and bathrooms. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The laundry area is fitted with domestic type appliances with residents being responsible for attending to their own laundry each week. Hand wash facilities have been provided in all areas where needed for the effective control of the spread of infections. The AQAA completed by the manager describes the plans for improvement within the next twelve months We will be developing smaller units within the structure where two people can share. This is to maximise greater independence and less staff dependence. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are satisfied that the care they receive meet their needs, and feel the staff are able to support them, when they want support. They feel that staff are trained and able to deliver their care needs. Evidence: The home is managed and staffed with a team of qualified registered nurses and care staff. The manager stated that all current staff have have been accredited with a National Vocational Qualification levels 2-4. General observations of staff working practice, discussions with people living and working at the home suggests that the staffing complement, skills and experiences are satisfactory for the needs of the current resident population. This was supported by the observations of the expert by experience - Generally, Millenia House was doing an excellent job offering exceptional care with compassionate support to a group of very difficult young adults. A selection of personnel files were looked at and contained the required information and checks to evidence that suitable and safe recruitment practices are in operation. A Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: training and development programme has been implemented to ensure that staff receive the required training in the core and specialist topic areas at the appropriate times. The personnel files contain certificates and accreditations of the training that has been completed. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has the required qualification and experience, is highly competent to run the home and meets its stated aims and objectives Evidence: Mr George Dixon is the owner/manager for the home and has many years experience with managing the care service. He has a great depth of knowledge with caring for this group of people. Clear lines of accountability have been established with Mr Dixon leading the staff team effectively and efficiently. Mr Dixon guided and supported the expert by experience during the time of the inspection, with the expert documenting- Many of the residents can be very challenging at times, the manager offered me guidance when interviewing. Many people discussed the management style of the manager and complained to me about how hard he was on them, but it was very obvious that they also respected him and obeyed his rules. I felt very satisfied that the home was providing an excellent mix of protective care and empowered freedom to a very difficult group of people. It was Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: obvious that the manager was totally dedicated to his residents and passionate about helping them progress and develop whilst having to deal with their aggressions and violent moods. Quality assurance and monitoring of the service continues on a limited scale with audits of working practices being carried out, staff and resident meetings and policies and procedures being reviewed. An external contractor is responsible for overseeing the health and safety of the equipment and premises. Records are maintained of the routine checks that are needed. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The service user guide should include details of the weekly fees and what is included in the fees. This will ensure that people have the information they need to make an informed choice about the service. The service user guide should include details of how to make a complaint should they wish to do so. 2 22 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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