Care Home: Millerbank

What the care home does well This inspection visit showed the acting manager was working hard to make a number of improvements at the home. The home had already recognised the need for further improvements and plans were being made to make changes for the benefit of people using the service. There were some good ways of finding out about peoples individual needs` and choices before they moved in to the home. So people could get a feel for the home before they moved in, they were being invited to visit for short periods and weekends. People had individual written plans describing their needs and how staff should support them, the plans had been agreed with each person and were being updated to provide better information. People were being involved with making decisions about their support and lifestyles. They were being encouraged to develop Independence skills. Support was being given with health-care needs, medication and appointments. People were getting out and about in the community and were keeping in touch with families and friends. Any complaints made were being taken seriously and properly dealt with. To help make sure staff provide good support, they were being given regular training. What has improved since the last inspection? To better protect people using the service, full employment histories were being obtained as part of the staff recruitment process. People using the service were being involved with choosing new staff. People were being more involved with planning their own menus, to encourage greater independence and choice. Some parts of the home had been re-decorated and upgraded to provide a more comfortable and pleasant home. What the care home could do better: A manager needs to register with the Commission to take legal responsibility for running the home. To make sure the home provides a good standard of accommodation for people, the plans to make improvements need to be put into action as soon as possible. As the lounge is for the people living at Millerbank, it should not be used as a staff office.Some house rules and routines needed to be reviewed to make sure peoples` individual needs, rights and choices are properly respected. To make sure people get the individual support they need, staffing levels must always ensure there are enough staff available. To make sure people are properly protected, some guidelines for staff needed to be improved to include better information. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Millerbank 27 Carlton Road Burnley Lancashire BB11 4JE     The quality rating for this care home is:   two star good 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: Jeffrey Pearson     Date: 1 9 0 8 2 0 0 9 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. 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. 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Millerbank 27 Carlton Road Burnley Lancashire BB11 4JE 01282423686 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Tranway Associates Limited care home 6 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 6 The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD. The maximum number of service users who can be accommodated is: 6. Date of last inspection Brief description of the care home Millerbank is a care home registered to provide accommodation for six younger people, aged 18 to 65, with mental ill health. Tranway Associates Ltd own the home, and the Responsible Individual is Mr Ian Smith. The home is an older type end terraced property close to Burnley town centre and people using the service therefore have easy access to the towns facilities. There are 2 single bedrooms and 2 shared bedrooms. None have en-suite facilities. The home aims to provide a structured environment and routines, to meet the needs of individuals, by encouraging self development and independence skills. Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home The home had available, a Statement of Purpose and Service user Guide. This written information, which is given to all prospective residents and their relatives, explains the support and accommodation available and provides an indication of what people can expect if they choose to use the service. At the time of the inspection visit the range of fees was between £523 and £1008 per week. There are no additional charges. Care Homes for Adults (18-65 years) Page 5 of 29 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: two star good 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: An unannounced inspection which included a visit to the service was conducted at Millerbank on the 19th August 2009. The visit took 8 hours and was carried out by one inspector. People using the service were invited to complete surveys, to tell the Commission what they think about the support and care provided by the agency, some were returned to us. Before the visit the manager was asked to complete and return to us an annual Quality Assurance Assessment (AQAA). This was to enable the service to show how they were performing and provided details about arrangements, practices and procedures at the Care Homes for Adults (18-65 years) Page 6 of 29 home. The files and records of 2 people were examined as part of case tracking, this being a method of focusing upon a representative group of people using the service. We spoke with residents, the acting manger and staff. Various documents, including policies, procedures and records were looked at. Parts of the home were viewed. The home was last inspected on 26th June 2007 we carried out an annual review of the service on 23rd April 2008. What the care home does well: What has improved since the last inspection? What they could do better: A manager needs to register with the Commission to take legal responsibility for running the home. To make sure the home provides a good standard of accommodation for people, the plans to make improvements need to be put into action as soon as possible. As the lounge is for the people living at Millerbank, it should not be used as a staff office. Care Homes for Adults (18-65 years) Page 8 of 29 Some house rules and routines needed to be reviewed to make sure peoples individual needs, rights and choices are properly respected. To make sure people get the individual support they need, staffing levels must always ensure there are enough staff available. To make sure people are properly protected, some guidelines for staff needed to be improved to include better information. 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.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 9 of 29 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 10 of 29 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. The admission process ensured peoples individual needs, abilities and preferences were known and planned for before they moved into the home. Evidence: There was an indication in service user surveys that people had been involved in choosing the home, also that they had received enough information about Millerbank to help them decide if it was the right place for them. The acting manager said the guide to the home was in the process of being updated, to provide more accurate and useful information. It was suggested people using the service be involved with this task as an activity. The assessment and referral process was discussed with the acting manager, who explained that people are visited in their own environment, with information being obtained from the service user, their families and professionals such as hospital staff and care workers. Referrals are mostly made through social services or the health authority, the manager said requests were made from all relevant information. Policies Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: and procedures were available in support of the admission process. The paperwork used for finding out about people helped make sure good information was obtained and considered. Such as, information about medical conditions, oral health, medication, mobility, personal hygiene, activities of daily living, psychological wellbeing, work and education, family support and lifestyle. Case tracking of service users files, showed assessments had been carried out and information obtained from other agencies, before people had been offered a place at the home. One assessment seen was very sensitively written in a person centered way, it included comments on the persons understanding of the referral and admission process along with the reasons for the type of support being offered. Records and discussion showed systems were in place for prospective service users to visit the home for trial periods, including half day introductory visits, overnight stays and weekends at the home, to help them become familiar with the service and meet with people. One person spoken with said they had been to the home before accepting the placement. The AQAA (Annual Quality Assurance Assessment) provided good information about the admission process and indicated that existing service users were to be more involved with considering the compatibility of any new people. Care Homes for Adults (18-65 years) Page 12 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning process at Millerbank helped ensure peoples individual needs were known and responded to. Evidence: Systems were in place to ensure people using the service have their needs identified and responded to in individual plan of care. People using the service indicated in surveys and discussion an awareness and involvement with their individual plans. Staff spoken with said they were always advised of any changes in peoples support needs, and if they were unsure about anything would check care plans. Care plans seen included relevant information about peoples needs abilities and goals, including skill development and rehabilitation. There were also specific plans in relation to relapse triggers and behavioural needs. Care plans were sensitively written and included a I plan to do section, which promoted a more person centered approach. Records and discussion showed care plans were being drawn up and reviewed with service user and the involvement of Care Coordinators. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: The acting manager said care plans were to further developed, to provide more detailed person centered information, also recording systems were to be streamlined to more effectively respond to identified care plan goals and needs. This intention had been highlighted as an area for future improvement within the AQAA (Annual Quality Assurance Assessment) People living at Millerbank were being involved with decisions about their lives, this being reflected within the care planning process, in particular the activities of daily living, such as, cooking, domestic chores, outings and family contact. They were also being more actively involved with the recruitment and selection of new staff. Some care plans included agreed limitations in relation to alcohol and accessing the community. The home had a Department Of Health guide on supported decision making and information about advocacy services was available in the home. The AQQA indicated that individual risk assessments had been further developed to consider peoples past history, their mental well being, ill health symptoms and relapse indicators. Records seen showed risk assessments had been carried out in relation to significant matters. The acting manager said, she was intending to ensure risk assessment information and strategies were more effectively included in care plans. It was advised generic and individual risk assessments be carried out in relation to outdoor activities, such as extreme sports, to ensure a reasonable balance is a achieved between personal safety, rights, choices and fulfillment, the acting manager agreed to take action in response to this matter. Care Homes for Adults (18-65 years) Page 14 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were receiving some support to engage in activities, use community resources and keep in touch with families and friends. Evidence: The AQAA (Annual Quality Assurance Assessment ) showed activities were being focused upon as an area for improvement. The acting manager said she was proposing to introduce a more individual approach. Activity plans were in the process being devised with each person using the service. Copies were to be kept in each persons room to keep them informed about their agreed activities programme. People using the service spoke of the various individual and group activities they were involved with, including, shopping, swimming, cinema and college courses. Im going to the football match tonight explained one person. Although one to one and group Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: activities, outings and community involvement, was ongoing, this was very much influenced by the availability of staff support. One comment from staff was, If we had more staff, we would be able to do more things with the residents (See staffing) Independence living skills were being encouraged, people had some responsibilities for domestic chores as part of rehabilitation process. There were some general house rules and established routine practices at Millerbank, which may unduly influence some lifestyle choices, for example, bed times and restricted access to food. The acting manager had already begun to address some of these matters, advice was offered on evaluating current practices with people using the service, staff and Care Coordinators. Records and discussions showed peoples relationship needs were being considered, people were being supported to keep in touch with families and others as appropriate. A policy about relationships and visiting arrangements was on display in the home. People spoken with said they were happy with the catering arrangements at Millerbank. The manager said they had recently revised the menu planning system to be more individual, meal choices were now being discussed with each person daily. Records were seen of meals being planned for and taken, peoples diets were being monitored and healthy eating encouraged. The acting manager said information on healthy eating was being obtained, to help educate people using the service and staff about this subject. To promote independence skills, one person had their own meals budget, they planned, shopped for and cooked their own meals. Care Homes for Adults (18-65 years) Page 16 of 29 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. Health and personal care practices were effective in ensuring peoples needs are properly and safely met. Evidence: The care plans included peoples agreed support needs in relation to health and any personal care. People were generally being supported to take an interest in their appearance, hairdressing and clothing, it was apparent individual choices and preferences were being respected. Interactions observed between people using the service and staff appeared sensitive. Staff were genuine and respectful in their approaches when providing support and guidance. People spoken with said they had contact with GPs and other medical professionals such as consultants. The acting manager said health care was presently being focused upon at the home. Arrangements were in place for people to have an annual health check, action was being taken for all people using the service to have a medical check with their GP. People were being supported to attend routine and urgent medical appointments as necessary. Mental health and physical conditions were being Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: monitored and responded to as part of the care planning process. The AQAA (Annual Quality Assurance Assessment ) showed that within the next year, staff training was to be reviewed, to ensure relevant health care matters are included in the mandatory training programme for all staff. The acting manager said all staff had received training in medication practices. Records showed, staffs competence in manging medication had been evaluated. Medication polices and procedures seen to be available, these were due to be reviewed in line with recognised good practice guidance. Peoples ability to manage their own medication was considered with their Care Coordinators when moving into the home. Individual assessments had also been carried out with people who were managing some of their medication. It was suggested each person be assessed, to show appropriate consideration had been given to each persons ability. Medication records seen were clear and accurate. Care plans included individual instructions and assessments in relation to when necessary medication. Medication storage was satisfactory, however, it was advised a more suitable cabinet be obtained, the acting manager said this matter was already being pursued. Care Homes for Adults (18-65 years) Page 18 of 29 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. Most policies, procedures and practices provided safeguards for people using the service and supported the complaints process. Evidence: People completing surveys and those spoken with had a general awareness of the homes complaints procedures. One comment made was Oh yes I would complain if I was not happy. Staff spoken with explained how they had actively supported people to raise concerns. The acting manager said the complaints procedure had been verbally discussed with the last person to have moved into the home. The complaints procedure seen on display in the hallway did not include up to date details of the Commission. The acting manager agreed to ensure the procedure provides clear up to date, accessible information. It was advised Social Services contact details also be included in the complaints procedure. Records and discussions showed complaints were being taken seriously and were being effectively managed. Complaints processes were discussed with the acting manager, including being objective and ensuring appropriate investigation strategies are devised and accountable records kept, to show clearly how complaints have been managed. The acting manager and staff spoken with expressed a good understanding of the action to be taken in response to any allegations, incidents or suspicions of abuse. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: People using the service indicated in surveys they knew who to speak to if they were not happy. Appropriate action had been taken to ensure support practices at Millerbank provide effective safeguards for people using the service. Information was displayed for people using the service about protection and abuse, including contact details of relevant agencies. Safeguarding and protection policies were available which included some relevant information, however, there were no specific procedures for reporting incidents, the acting manager agreed to address this matter. Similarly, the reporting bad practice Whistle Blowing policy included some good information, but was incomplete, as it did not have contact details of Social Services or the Commission. The AQAA (Annual Quality Assurance Assessment ) showed that within the next 12 months, staff were to receive protection of vulnerable adult training and the physical intervention policies were to be reviewed and updated. Care Homes for Adults (18-65 years) Page 20 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Millerbank provided a clean and comfortable place to live, some improvements were needed for the benefit and wellbeing of people using the service. Evidence: People spoken with expressed an appreciation of the accommodation provided at Millerbank, in particular their bedrooms, one person said I like my room, I have my own belongings and a key to the door. Some parts of the home had been recently been redecorated, including the dining room and bathroom, people using the service had been consulted on the choice of colour schemes. There was a large accessible paved yard area to the side of the home, with benches, plants and shrubs also a covered area for smoking. The outside front of the home was seen to be unkempt, the letterbox was displaced and there were weeds growing in the garden forecourt. The lounge was decorated and furnished to a very good standard, furnishings were contemporary in style providing a comfortable, pleasant environment for people to relax, watch television and socialise. However, the front part of the lounge was being used as the administration office, which meant living space for people using the Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: service had been reduced, also the lounge was was not always accessible to them due to the confidential meetings and discussions taking place. The acting manager said significant environmental changes were being considered at the home, including en-suite bedrooms, appropriate office and communal space. There was a clear indication within the AQAA (Annual Quality Assurance Assessment ) that within the next 12 months, plans were to be drawn up and implemented to make a number of improvements to the accommodation at Millerbank, to better meet the needs of current, and future service users. The home was found to be clean and free from unpleasant odours, suitable laundry facilities and equipment was available. Care Homes for Adults (18-65 years) Page 22 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although progress was being made, not all staffing arrangements were satisfactory in ensuring people using the service receive effective person centered support. Evidence: Records and discussion showed staff training was being given attention at Millerbank. Most support staff had NVQ (National Vocational Qualifications) level 2 or 3 in health and social care. Records were seen of training undertaken and planned for, for example fire safety training had been arranged for the day after inspection. The acting manager was aware of the need to ensure all staff receive appropriate training and updates. All staff were expected to complete Introduction to Mental Health training. Individual training needs were being identified and agreed with each staff member. The AQAA (Annual Quality Assurance Assessment ) showed that in the next 12 months training pathways were to be evaluated, to ensure staff have the necessary skills to deliver an effective service. People spoken with were generally satisfied with the support they received at Millerbank, they described the staff as alright. Staff rotas and discussions showed that on occasion, there had been insufficient staff available to properly provide for peoples individual support needs. The AQAA showed that there had been a number of Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: changes in the staff team at Millerbank and that arrangements were being made to recruit additional staff, to ensure peoples support needs are effectively and safely met. Agency staff were being used as necessary. The acting manager explained the action being taken to address this matter and it was apparent some progress had been made, with a new employee commencing duty at the time of the inspection. The AQAA provided a clear indication and assurances that additional staff were to be available in the evenings and at weekends, this will ensure effective support can be provided in a person centered way. The Commission therefore expects, the proposed plans to improve staffing levels to be implemented. Staff recruitment records and procedures were mostly satisfactory and showed appropriate checks and interviews had been carried out, one written reference was unable to be located, however, the acting manager gave assurances that a satisfactory reference had been obtained. It was advised it would be useful for dates of education to be requested and noted to enable more effective audit of peoples backgrounds. It was considered good practice that people using service were being more involved with the recruitment process, the AQAA also showed further progress was to be made with devising role specific questions and reviewing job descriptions. The induction training records of more recent employees showed systems were in place to provide initial training over a 12 week probationary period, a checklist had been completed and signed and dated by the employee and supervisor. During this period new staff work alongside more experienced staff on a variety of shifts. One staff member spoken with confirmed they had received initially induction training and had been supported to complete NVQ level 3. Care Homes for Adults (18-65 years) Page 24 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. For the benefit and well being of people using the service, effective leadership and good management practices need to continue at Millerbank. Evidence: Since the last inspection there had been a change of manager at the the home, at the time of this inspection, the acting manager had been in post for approximately 9 months. During this time it was apparent she had identified several areas for improvement and had started to implement changes, these being previously highlighted within this report and more significantly in the AQAA (Annual Quality Assurance Assessment). The acting manager was very proactive in her response to the inspection process and appeared competent and knowledgeable in the role. People using the service and staff spoken, with made positive comments about the acting manager, one staff described her as, Very approachable. At the time of the inspection visit the acting manager had not applied to be registered. The acting manager had not been provided with an up to date job description, and had Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: not received any formal one to one supervision. The home owner will therefore need to take action in response to these matters. The home had policies available in relation to quality assurance. The acting manager said she had consulted with people individually, about the services being provided at Millerbank. Also that she was aiming to give out individual questionnaires very soon, consideration was being given to consulting with Care Coordinators, relatives and staff. As indicated, the AQAA included some good information and plans for development, the acting manager said completing the assessment had been very useful. Advice was offered on using the AQAA more effectively as part of the Quality assurance process, in particular using results from surveys as evidence of consultation. Arrangements were in place for staff to receive training in safe working practices, the AQAA and records seen showed the ongoing maintenance and checking of facilities and installations. Health and safety risk assessments were seen to have been completed. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 23 To help provide safeguards for people using the service, protection policies and procedures should provide clear step by step instructions for mangers and staff to follow, when reporting incidents allegations or suspicions of abuse or neglect. Procedures should also include the contact details of agencies where alerts are to be made. To ensure people using the service are effectively, consistently and safely supported, staffing arrangements must be more appropriately managed. Recruitment practices should ensure appropriate records and references are kept secure, to show all the necessary checks have been carried out for the protection of people using the service. So there is someone to take legal responsibility for the day to day running of the home, the acting manager should submit an application for registration to the Commission as soon as practicable. 2 33 3 34 4 37 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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. Copyright © (2009) 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. 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