Care Home: Millwater

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What the care home does well This is a random inspection and therefore not all the core standards were assessed. People living at the home are helped to keep in touch with their family and friends so they can maintain relationships that are important to them. Staff support people to go out shopping and choose their own clothes so they can wear the clothes that suit their individual style. One person said, " I like it here, it`s my home now." Each person has their own bedroom with their own en suite toilet and shower or bathroom, which gives them privacy. When people complain they are listened to and things are done to help improve the home. Relatives said, " I cannot fault the home, it`s 110 per cent!" What the care home could do better: This is a random inspection and therefore not all the core standards were assessed. Staff must have the information they need so they know how to support each person to meet their needs to ensure their well being.Staff must monitor people`s health needs and ensure that where needed medical advice is sought so that people get the help they need. People`s weight must be monitored and action taken where needed to ensure individual`s health and well being. Staff should ensure that they support the people living there with dignity and respect so ensuring their well being. Alternative entrances to and exits from each unit should be looked at to ensure the privacy of the people who live in Swan unit. All staff must have training in safeguarding so they know how to safeguard the people living there from abuse. Staff must have the training they need so they know how to support the people living there to meet their needs. Random inspection report Care homes for adults (18-65 years) Name: Address: Millwater 164-168 Waterloo Road Hay Mills Yardley Birmingham B25 8LD one star adequate service 02/12/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sarah Bennett Date: 1 4 0 4 2 0 1 0 Information about the care home Name of care home: Address: Millwater 164-168 Waterloo Road Hay Mills Yardley Birmingham B25 8LD 01217063707 01217655536 Telephone number: Fax number: Email address: Provider web address: www.schealthcare.co.uk Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : West Regent Ltd care home 18 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 18 The maximum number of service users who can be accommodated is 18. 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: Learning Disability - Code LD, of the following age range 18 and 65 years (maximum number of places 18). Date of last inspection Brief description of the care home Millwater Care Home has been registered to provide a learning disability service for up to 18 younger adults. The home is separated into three units Swan, Dove and Wren. Generally people spend their time in the unit in which they live but do from time to Care Homes for Adults (18-65 years) Page 2 of 13 0 3 0 2 2 0 1 0 Brief description of the care home time visit people living in other units. Accommodation is in single rooms with en-suite facilities. There is a communal lounge and dining area in each unit and in Swan unit there is an activity room. Each unit has its own kitchen. There is a separate laundry in Swan unit. Facilities for laundry are available in the kitchens in Dove and Wren units. The grounds are fully enclosed with access from inside the building only. There is a small area outside the main entrance for off road parking. The home is situated close to major bus routes in and out of Birmingham City Centre.Local shops and amenities are within walking distance and the Swan Shopping Centre is approximately one mile away. The service users guide states that the last inspection report is available on request from the manager or in the homes reception area. The service users guide stated that the fees charged depend on individual assessment. These include accommodation, 24 hour staffing, all meals and beverages, laundry except dry cleaning and in - house activities. This information was current at the time of the inspection and the reader may wish to contact the care service for updated information. Care Homes for Adults (18-65 years) Page 3 of 13 What we found: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last key inspection of this service was completed on the 1st and 2nd December 2009. This random visit was undertaken by one inspector over eight hours. There were 15 people living there. The home did not know that we would be visiting that day. The reason for this visit was to check compliance with the requirements made at the key inspection. We did not look at the requirement relating to medication management, as a pharmacist inspector visited at another date to do this. They found these had been complied with. During this visit we looked at four peoples care files in detail and at staff training records. We spoke to the people living there, two relatives visiting, the manager, deputy manager, clinical governance manager and staff. These are our findings: Some improvements had been made to care plans and risk assessments but further improvement was needed to ensure staff know how to support the people living there. For example, one persons records stated that they had diabetes but there was not a care plan in place as to how staff were to support them with this. Staff had not received training as to how they are to support people who have diabetes. It was identified that one person had a blood disorder but their records did not state how this affected them and what support they may need because of this. One persons care plan stated that they wore pads to help them with their incontinence. It did not state what size or type of pad the person needed to wear. This could result in them not being supported appropriately to ensure their health and personal care needs are met. One persons care plan stated that they needed to eat soft foods to help prevent the risk of them choking. It stated to avoid high risk foods. It was not clear what consistency of soft food the person needed or what foods were a high risk to them. This could result in them being at risk of choking. However, staff spoken to stated that they knew what food the person should eat to reduce the risks. One persons daily records showed they had broken skin on their heel but their care plan had not been updated to state this. Their daily records did not state what action had been taken to promote healing to the persons skin. This could result in the persons skin breaking down further, which could seriously impact on their health and well being. One person had a care plan for communication. The Speech and Language Therapist had been involved and had suggested that to help the person communicate they could use objects of reference. For example, this could be if a person shows a cup, that they want a drink. The care plan did not state what objects they would use to state what they wanted so staff would not know how to help them communicate their needs and wants. Care Homes for Adults (18-65 years) Page 4 of 13 One person had recently been admitted to hospital as they were constipated. Their records showed that staff were aware several days before that the person had not opened their bowels. A lack of communication between staff had resulted in the person not getting the support they needed. The operations director had reported this issue as safeguarding and was taking action to reduce the risks of this happening again. Peoples records showed that they had not been weighed for several months. Their care plans stated in order to meet their needs the person needed to be weighed regularly. For one person it stated that they were at risk of being under nourished and were prescribed supplements to help with this. A significant loss or gain of weight can be an indicator of an underlying health need so it is important that to meet peoples needs their weight is regularly monitored. One person had recently had a catheter fitted. Staff were ensuring this was emptied regularly and were liaising with the district nurses to ensure appropriate care was given to the person around the site where the catheter was fitted. The catheter bag was hanging on the side of the persons wheelchair, so that other people and visitors could see this. This does not respect the persons dignity and should be covered. We observed improvement in the way staff communicated with the people living there. One person was observed talking to staff about their slippers being worn. Staff reassured them that they could go out and buy some new ones and arranged this. The person was happy with this and made the decision to throw their old slippers away. Due to the persons needs this could be difficult for them but staff reassured them and supported them well. However, we also observed staff not being aware of how to support a person to get ready to go out so they did not feel anxious and benefited from the outing. A senior member of staff supported staff well so the person could enjoy their time out in the community. Staff working with the person did not seem to know how to prepare them to go out or what they needed to take with them. Some records looked at did not show that staff respected people as an individual and know how to support them with their behaviours. Some records that stated what the person had done during the day stated in a bad mood or kicking off. This does not show that staff have the experience and insight to think about why the person may be behaving in this way and what they can do to support them. The home is split into three units, Swan, Dove and Wren. When we last visited the home was being run on a day to day basis as one unit and several people congregated and walked through the lounge in Swan unit throughout the day. This made it difficult for the people living in Swan unit to relax in their lounge. Staff are now allocated to work in a particular unit so they get to know the people living there well and can support people more as individuals. There were still some times when staff and people walked through Swan unit lounge to get to the other units. This was discussed with the manager and clinical governance manager who were going to look at people using alternative entrances to each unit. Some rooms had been redecorated and some new furniture provided to make the home more comfortable for people to live in. New tables and chairs had been provided in the Care Homes for Adults (18-65 years) Page 5 of 13 dining room in Swan unit, which made it better for people to sit and eat their meals. For some people specially adapted chairs had been provided to make it more comfortable for them to sit in and get in and out of their chairs. In Wren unit we noticed that an aerial cable was hanging down from the ceiling. Part of this had been tied up but there was still sufficient cable for this to be a risk to the people living there. The manager said they would ensure this was made safe. We looked at staff training records and found that staff were getting more training so they know how to meet peoples needs. We made a requirement regarding all staff having safeguarding training at the last inspection. The timescale for this to be met was 31st May 2010. We saw that progress is being made in this and 76 per cent of staff had received this. During the day a tutor from a local college visited and enrolled more staff to do their National Vocational Qualification (NVQ) in health and social care training. This should help staff to have the skills and knowledge to know how to meet the needs of the people living there. Although the progress we expected to be made in ensuring that people are supported appropriately had not been made, from speaking to the manager we are confident that the required improvements will be made. The manager had been in post a week. Conversations with them showed they had identified what was needed and understood how care planning should be done. The home had been supported by a project manager and during this time significant improvements in care planning particularly had been made. Unfortunately they had to take emergency leave but were due to return to the home the following week. What the care home does well: What they could do better: This is a random inspection and therefore not all the core standards were assessed. Staff must have the information they need so they know how to support each person to meet their needs to ensure their well being. Care Homes for Adults (18-65 years) Page 6 of 13 Staff must monitor peoples health needs and ensure that where needed medical advice is sought so that people get the help they need. Peoples weight must be monitored and action taken where needed to ensure individuals health and well being. Staff should ensure that they support the people living there with dignity and respect so ensuring their well being. Alternative entrances to and exits from each unit should be looked at to ensure the privacy of the people who live in Swan unit. All staff must have training in safeguarding so they know how to safeguard the people living there from abuse. Staff must have the training they need so they know how to support the people living there to meet their needs. 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 2. Care Homes for Adults (18-65 years) Page 7 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 23 13 All staff must receive training 31/05/2010 in safeguarding. To ensure they know how to safeguard the people living there from abuse. 2 35 12 Staff must have the training they need. So they know how to support the people living there to meet their needs. 31/05/2010 Care Homes for Adults (18-65 years) Page 8 of 13 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, 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 1 6 12 Care plans and risk 31/07/2010 assessments must clearly state how peoples needs are to be met. So that staff know how to support them to meet their needs and achieve their goals. 2 19 12 Individuals weight must be monitored. To ensure peoples health and well being. 31/05/2010 3 19 12 Staff must monitor peoples health and well being. To ensure they receive appropriate health care so their needs can be met. 15/05/2010 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 2 Assessments before people move into the home should be Page 9 of 13 Care Homes for Adults (18-65 years) 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 detailed so it is clear whether or not their needs can be met. Not assessed at this random inspection. 2 6 Staff should have training in how to communicate effectively with individuals to ensure that their frustration is reduced and they can communicate what they want and need. Not assessed at this random inspection. Activities should be provided that people enjoy doing and develop their skills so ensuring their well being. Not assessed at this random inspection. Care plans should state what activities the person enjoys and how they need to be supported to do this. Not met at this inspection. People should be supported to do activities that are appropriate to their age and during the evenings if they want to, so they can experience a meaningful lifestyle. Not assessed at this random inspection. People should be given more opportunities to do household tasks to develop their independence and self esteem. Not assessed at this random inspection. Menus should be provided using pictures to help people understand these better. Not assessed at this random inspection. Menus should reflect the choices of individuals so they have the foods that they enjoy helping to ensure their well being. Not assessed at this random inspection. Staff should support people appropriately when they are eating or drinking so to respect their dignity. Not assessed at this random inspection. Staff should support people who use a catheter appropriately so to support them in a dignified manner. Staff should weigh people regularly to ensure they are not at risk of being malnourished, which would impact on their well being. Not met at this inspection. All the people living there and their family and friends Page 10 of 13 3 12 4 12 5 13 6 16 7 17 8 17 9 17 10 11 18 19 12 22 Care Homes for Adults (18-65 years) 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 should know how to make a complaint if they are unhappy with the service provided. Not assessed at this random inspection. 13 24 Alternative entrances to and and exits from each unit should be looked at to ensure the priovacy of the people living in Swan unit. Furniture should be replaced where needed to ensure that the home is comfortable and homely for people to live in. Not assessed at this random inspection. Toilet seats should be replaced as needed to ensure that the risk of cross infection is minimised. Not assessed at this random inspection. Staff should ensure that the risks of cross infection are minimised as much as possible. Not assessed at this random inspection. At least fifty per cent of staff should achieve NVQ level 2 or above in Care so they have the skills and knowledge to meet the needs of the people living there. Not assessed at this random inspection. More staff should be recruited so the people living there are supported by staff that know them well. Not assessed at this random inspection. There should be at least six staff meetings a year so that staff can be updated with changes to the needs of the people living there, within the organisation and best practice. Not assessed at this random inspection. Two references should be sought for each member of staff that is employed to ensure they are suitable to work with the people living there. Not assessed at this random inspection. Staff should have at least six formal supervision sessions with their manager each year so they are supported in their role. Not assessed at this random inspection. Staff should write records about peoples health and behaviour in a way that shows that they respect them as a person. 14 24 15 26 16 30 17 32 18 33 19 33 20 34 21 36 22 41 Care Homes for Adults (18-65 years) Page 11 of 13 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 23 42 All staff should be aware of how to respond if there is a fire in the home to ensure their safety and that of the people living there. Not assessed at this inspection. Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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