Care Home: Millenium Care (Fox Lane)

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What the care home does well The home provides a high standard of care and support to a group of service users with a range of complex needs. The home by working consistently and professionally with the service users in partnership with other care professionals is able to support the service users to make significant progress with their personal development. The manager and staff demonstrated a good knowledge of the service users and were able to recognise their individual needs and how to respond appropriately to them. The service users are supported to have their individual needs met by a comprehensive care planning system, which incorporates ongoing review meetings. The service users are supported to develop their independent living skills in the home and community, based on their individual needs. Service users are supported to access a range of educational and leisure activities based on their individual interests and this enables them to have participation in the local community. The home has a well established and stable team of staff who are being supported by the manager. What has improved since the last inspection? The requirements of the last inspection have been met. What the care home could do better: The recommendation from this inspection is to ensure that staff undergo training in the Mental Capacity Act. Key inspection report Care homes for adults (18-65 years) Name: Address: Millenium Care (Fox Lane) 89 Fox Lane London N13 4RR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diaman Balraj     Date: 2 9 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Millenium Care (Fox Lane) 89 Fox Lane London N13 4RR 02088828171 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Millenium Care care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Millenium Care (Fox Lane) is a registered care home, which provides residential service for seven adults who have a learning disability. The home is located in a quiet residential area within a few minutes walk from shopping and transport facilities of Palmers Green. The home is run by Millenium Care a company, which operates a similar residential home nearby. Facilities at the home include seven single bedrooms, a kitchen, a dining room, and a large lounge at the front of the house, a shower room, a bathroom and three toilets. There is a space for car parking at front of the building. At the back of the building there is a garden, which is accessible through the kitchen. From 9am to 3pm Monday to Friday all service users and staff are out of the premises. In the event of an emergency staff can be contacted via the sister home Old Park. Or the registered manager can be contacted via his mobile phone number. Both contact numbers have been given to the relevant day centres or colleges. At the time of the inspection there were seven service users living in the service. The current range of fees in the home is from #676 - #1100 a week. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Care Homes for Adults (18-65 years) Page 4 of 24 Over 65 0 7 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 24 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: The inspection took place on the 29th July 2009 and was unannounced. The inspection lasted six hours and was the key annual inspection. The inspector was able to meet and speak to and observe the support given to 3 of the current service users. The inspector was able to spend time talking to the manager and his line manager as well as two members of care staff who were working in the home. The inspector did a tour of the premises and also looked at a range of records including service users records, staff files and health and safety documentation. Care Homes for Adults (18-65 years) Page 6 of 24 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 24 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 8 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have been supported to have their assessments updated so the home fully understands and can meet their individual needs. Evidence: The inspector looked at 3 service users files. They each have comprehensive assessments that look at all aspects of their physical, social, cultural and emotional needs. These assessments are based on staffs detailed knowledge of the service users individual needs. In addition the files had a life history which includes information about their family. This provides valuable information for staff to form a holistic view of each individual and how best to meet their needs. Interviews with staff and management showed that staff had clear understanding of service users individual needs and how best to support them. Tjhe inspector observed that the staff were supporting the service users in an appropriate manner that reflected their knowledge and understanding of their individual needs. The service users were also observed to be comfortable and relaxed within their home environment. Care Homes for Adults (18-65 years) Page 9 of 24 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. Service users have comprehensive care plans and risk assessments. These enable service users to work towards clearly defined goals agreed in partnership with families and other care professonals. Service users are supported to make decisions about their daily lives within the home and service user meetings take place regularly. Evidence: Three service users files were inspected. Each service user has detailed individual care plans. These reflect the decisions made at each service users review meeting. Residents are supported to make decisions about their personal goals. These meetings take place with the care manager approximately once a year and there is also a review meeting arranged by the home on a six monthly basis. These review meetings were recorded and demonstrated multi disciplinary working. The care plan goals are divided into short and long term goals. These were clear and are monitored on a monthly basis. The care plans focus on supporting the residents to achieve greater independence or to engage in further activities or by addressing health care or behavioural issues. All service users have a named key worker. The files Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: inspected showed that there were clear guidelines on how to respond to behaviours and these are reviewed on a monthly basis. Restrictions are imposed if they prove necessary to safeguard the residents welfare. The reasons for restrictions are recorded in the service users care plans, risk assessment and behavioural guidelines. The files inspected showed comprehensive individual risk assessments covering all areas of potential risk and this identified what action the home would take in response to the identified risks whilst at the same time promoting each service users independence. The areas covered included securing the front door, accessing the community, safety during food preparation and mealtimes and bathing. The inspector was able to observe the interaction between staff and residents on their return from the day centre. Residents were asked what they wanted to drink and whether they wanted to have a shower or whether they wanted to go out or watch TV. The record of service users meetings was inspected. These took place on a regular monthly basis and discussed activities, holidays and things that were happening in the home. Care Homes for Adults (18-65 years) Page 11 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported to have full and active lifestyles. They also enjoy contact with their relatives and friends. the service users are offered a wholesome and healthy diet. Evidence: The service users access a range of activities based on their individual needs and interests. All the service users attend a structured activity from Monday to Friday. Four service users go to resources provided by social services or the voluntary sector and three service users access a day service arranged by Millenium Care that incorporates access to college courses. The leisure activities offered to the service users include going to the local Gateway club and enjoying a visit to the pub on a Friday evening. In addition other activities both inside and outside the home include picnics, cookery, helping in the garden and having a hand massage. Each service user has a daily activity record and the three Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: inspected showed that the service users were enjoying an active lifestyle and being supported to access local community resources. They also show that service users are active within the home and are being supported to develop their independent living skills. The manager explained that two of the service users enjoy going to church each week and two others choose to go on an occasional basis. Residents have been on a weeks holiday to Bognor Regis. The manager explained that all service users have contact with their families and friends. They are made welcome in the home or service users are supported to go to their family homes. It was observed that there was a friendly atmosphere in the home with staff chatting to the service users. A member of staff interviewed had first hand knowledge of service users likes and dislikes. The service users were observed to be very relaxed with staff. The menu for the week was inspected and this offered a healthy and varied diet. the manager explained that two of the service users are supported to have their food finely chopped and they all follow a healthy eating plan. The record of food provided reflected the menu. Residents are also provided with alternatives to the menu and this is recorded. Care Homes for Adults (18-65 years) Page 13 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to receive personal care according to their individual needs and wishes. Service users are supported to access health care services based on their requirements. Service users are protected by appropriate medication administration procedures. Evidence: It was observed during this inspection that the service users were given support with their personal care based on their individual needs. Service users were all very well dressed and groomed. The health care records of three service users were inspected. Service users records showed that they been supported to access the GP, dentist, optician and chiropodist for their primary health care checks. They all see the consultant Psychiatrist on a regular basis. It was noted that a number of therapy services including Psychology and speech and language therapy have been accessed as required for specialist advice. The medication systems in the home were inspected. The home uses the Lloyds pharmacy blister pack system. The medication was appropriately stored. The Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: medication administration records were in order. Training records were inspected for 3 members of staff and they all had received medication training. Care Homes for Adults (18-65 years) Page 15 of 24 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. Service users can be confident that they will be protected by well trained staff and robust adult protection procedures. Evidence: The home has a complaints procedure which is also available in picture format. Staff interviewed demonstrated good knowledge of the adult protection procedure and the whistle blowing policy. The complaints file showed that there had not been any complaints in the last 6 months. The inspector looked at the complaints record and was satisfied that previous complaints had been addressed appropriately. The inspector spoke with two residents who stated that they were happy and treated well by staff. They did not have any complaints. Care Homes for Adults (18-65 years) Page 16 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users live in a homely, comfortable and safe environment that is clean and well maintained. Evidence: The inspector did a tour of the home and looked at all the bedrooms. The home was clean and tidy throughout. Each service users bedroom was well furnished and was homely and personalized. The communal space consists of a large lounge, dining area and a separate kitchen. These were also well furnished and comfortable. There are adequate bathing facilities with a bathroom or shower room on each floor. The home has a laundry on the top floor All the equipment in the home was observed to be in good working order. Care Homes for Adults (18-65 years) Page 17 of 24 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. Service users are supported by a stable staff team. The staff receive a comprehensive induction and have an ongoing programme of training. Training in the Mental Capacity Act will further help staff to support residents. Evidence: The Inspector looked at the staff rota. The staff team consists of a manager, deputy manager, 2 senior carers and a team of carers. The staff turnover is very low. The manager explained that the home does not use agency staff. During the day there are two or three staff working according to the activities planned for the service users. At night there is one waking member staff and a second member of staff sleeping in. Records confirm that more than 50 of staff have got or are studying for an NVQin care. The recruitment checks for 3 members of staff were checked and were in order. the record of staff team meetings was inspected and these take place on a monthly basis and discuss a range of operational issues. The induction records for three staff showed that they had completed their induction training as required. The training records showed that staff had followed the mandatory training relating to Fire safety, medication, health and safety. Epilepsy training had also been followed by staff. There was evidence that staff had followed POVA training and interview with Care Homes for Adults (18-65 years) Page 18 of 24 Evidence: staff demonstrated their knowledge in this area. It is recommended that all staff follow training in respect of the Mental Capacity Act. Staff supervision records were inspected for three staff. All the staff were receiving regular individual supervision on a two monthly basis. The manager was also receiving regular supervision. Care Homes for Adults (18-65 years) Page 19 of 24 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. Service users benefit from living in a well managed service. The focus is on providing a high standard of care and support. health and Safety measures to protect service users are in place. Ongoing quality assurance monitoring systems underpin continuing improvement. Evidence: The manager possesses the NVQ level 4 in management in care and the RMA. The previous manager of the home, Mr Evans is now the managers line manager and was present during part of this inspection. The manager has the appropriate skills and experience to manage the home. The home has completed its most recent quality assurance exercise in February 2009. This has included asking service users, relatives, care professionals and other stakeholders to complete questionnaires. One comment from a stakeholder stated: The clients who attend the day service are well dressed, given a balanced packed lunch and supported well in order to achieve the best possible outcomes for the clients. Fire safety measures are in place. All fire safety records were in order. The home has Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: a fire risk assessment and evacuation plan. The certificates were in place to confirm the gas system and electrical installations, portable electrical appliances and water systems had been serviced. The current insurance certificate was displayed. The staff training records showed that staff had received appropriate health and safety training including fire safety, first Aid, moving and handling and food hygiene. Care Homes for Adults (18-65 years) Page 21 of 24 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 22 of 24 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 35 It is recommended that staff follow training in the Mental Capacity Act to update their knowledge so as to further improve the delivery of care. Care Homes for Adults (18-65 years) Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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