Care Home: Milton House

What the care home does well Residents know that the home will make sure it can meet their need before admitting them to the home. They are given enough information and offered trial visits to help them decide to live there. The home makes sure it can meet residents cultural and religious needs. Residents care and health needs are met and they are supported to take acceptable risks. They are able to make choices in their day to day lives and they participate in decision making in the home. Residents benefit from a good choice of onsite activities. They are supported to keep in touch with families and friends and to follow the religion of theirMilton HouseDS0000022999.V358229.R01.S.docVersion 5.2Page 6choice. Residents` dietary needs are met and they have a choice of regular meals. Residents care needs are met in the way that they choose. They have good access to heath care professionals. Staff are trained to give medication safely and support some residents to take their own medication. Residents know that their concerns will be dealt with. Staff know how to protect residents from abuse. Residents benefit from accomodation that is clean, well maintained and homely. Planned redecoration and refurbishment will further improve their accomodation. Residents are supported by enough staff who are trained to meet their needs. They are satisfied that staff treat them well and listen to what they say. A robust recruitment procedure helps keep service users safe. The home is well managed and residents views are sought to help develop the service. Health and safety systems keep residents safe. What has improved since the last inspection? The registered persons and the deputy manager have responded well to the requirements and recommendations from the last report. Overall there is an improvement in the organisation of records and management of the systems in the home. What the care home could do better: More drivers in the staff team would enable residents more community access. The record of water temperature checks to hot water outlets accessible to residents must be reviewed to make sure that staff take action and record this when temperatures are too high. CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Milton House The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ Lead Inspector Jill Chapman Unannounced Inspection 21st January 2008 10:40 Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milton House Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ 01494 601432 01494 871927 mary.hooba@epilepsynse.org.uk www.epilepsynse.org.uk The National Society for Epilepsy Mrs Mary Hooba Care Home 13 Category(ies) of Physical disability (13), Physical disability over registration, with number 65 years of age (0) of places Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the Home is to be registered to provide care for 5 (five) Service Users under the age of 65. That the home is also registered to provide care for 1 (one) Service User under the age of 30 until the 31st of July 2005. 6th July 2006 Date of last inspection Brief Description of the Service: Milton House is one of a number of residential and medical facilities that comprise the Chalfont Centre for Epilepsy. It provides personal care and accommodation for thirteen residents that suffer from epilepsy. The home has thirteen single bedrooms and two lounges. None of the bedrooms have en suite facilities. Accommodation at the house is all on ground floor level. It is situated in Chalfont St Peter not far from the village shop. Public transport and amenities are easily accessible. There is an established staff team who are supported by a range of health professionals employed on site. The fees for this service range from £696.28 to £1,655.22 per week. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 10:40am and was in the service for 6 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. The inspector spoke with some residents individually and some in a group in the lounge. The premises were seen and records relating to care, staffing and health and safety were sampled. Discussion took place with the deputy manager and staff on duty. The inspector was introduced to the home manager who was on duty but at meetings elsewhere on site. Surveys were received from residents , relatives and health and care professionals. Some of their comments are represented in the report. What the service does well: Residents know that the home will make sure it can meet their need before admitting them to the home. They are given enough information and offered trial visits to help them decide to live there. The home makes sure it can meet residents cultural and religious needs. Residents care and health needs are met and they are supported to take acceptable risks. They are able to make choices in their day to day lives and they participate in decision making in the home. Residents benefit from a good choice of onsite activities. They are supported to keep in touch with families and friends and to follow the religion of their Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 6 choice. Residents’ dietary needs are met and they have a choice of regular meals. Residents care needs are met in the way that they choose. They have good access to heath care professionals. Staff are trained to give medication safely and support some residents to take their own medication. Residents know that their concerns will be dealt with. Staff know how to protect residents from abuse. Residents benefit from accomodation that is clean, well maintained and homely. Planned redecoration and refurbishment will further improve their accomodation. Residents are supported by enough staff who are trained to meet their needs. They are satisfied that staff treat them well and listen to what they say. A robust recruitment procedure helps keep service users safe. The home is well managed and residents views are sought to help develop the service. Health and safety systems keep residents safe. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know that the home will make sure it can meet their need before admitting them to the home. They are given enough information and offered trial visits to help them decide to live there. The home makes sure it can meet residents cultural and religious needs. EVIDENCE: Residents surveyed showed that majority of residents were consulted about their move into the home. Some residents spoken with said they came from homes on site that were closing and they were all happy to be at Milton House. Most residents surveyed felt they were given enough information about the home before moving in. Some spoken with confirmed they came for trial visits. One resident saidI looked at the house and asked questions and in particular Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 9 were there any rules to follow and the manager said no, so I chose Milton House and Ive been happy ever since Discussion about the assessment procedure took place with the Deputy Manager. The file of a recently admitted resident was sampled and showed that a comprehensive assessment document has been developed as recommended at the last inspection. The assessment looked at all of the residents needs including religious and cultural needs. It was noticed that the section dietary requirements did not include a prompt about cultural dietary needs and it is recommended that this is added. The admissions procedure includes trial visits to the home. It was seen on documentation that these were scheduled but the records of these had been archived and were not available to be seen. The manager and deputy both confirmed that these visits had been recorded as recommended at the last inspection. Residents files sampled showed that they had been given a copy of their terms and conditions. The home does not offer an intermediate care service. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents care and health needs are met and they are supported to take acceptable risks. Residents are able to make choices in their day to day lives and they participate in decision making in the home. EVIDENCE: A previous recommendation that person centred care planning is introduced has been met. There has been good development in care planning since the last inspection, these were sampled and show that they are person centred. Residents’ preferences are shown in their Communication Passport. Care plan files sampled were well organised and clearly written. Daily records show that Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 11 care plans are carried out. A care manager surveyed said the most comprehensive care plan I have ever seen. A previous requirement that staff receive training in care planning and report writing has been met. Staff have also all attended an Equality and Diversity course. A previous requirement that care plans are regularly audited has been carried out. Records show that these are audited monthly and three monthly reviews are carried out with the resident. Records show that annual reviews are held with relevant professionals, family and the resident. Records show that residents are consulted about their care. Their consent is sought and they sign to enable staff to assist them with daily routines such as medication, personal care and bathing. Residents are asked if they have preferences regarding the gender of carer and these choices are documented. Risk assessments are in place to support where choice needs to be overridden due to safety reasons. Risk assessments need to be developed to support the need to monitor some residents while they are bathing. (See Standard 24) From surveys and discussion with residents, the majority feel they are able to make day-to-day decisions all of the time. This was observed and also confirmed in discussions with residents during the inspection. Residents said that they are consulted in decision making in the home and that regular residents meetings are held and any decisions documented. There was positive feedback from relatives’ surveys, the house care at Milton House is excellent, ‘they do well by giving love and understanding everything and my relative gets all the care and attention they need. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 13 11, 12, 13, 14, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a good choice of onsite activities but more drivers would enable more community access. Residents are supported to keep in touch with families and friends and to follow the religion of their choice. Residents’ dietary needs are met and they have a choice of regular meals. EVIDENCE: Residents confirmed that there is a variety of activities provided on site and a weekly timetable is provided so that they can choose what to do each day. Activity care plans are now in place as recommended at the last inspection and records of activities are kept are kept. One resident goes to an on site work placement five mornings a week on site and confirmed that the placement has been flexible to suit his changing needs. Residents spoken with said they enjoy keep fit sessions and learning computer skills. In house activities include board games, bingo; take away meals or meals out, barbeques and occasional trips out in the summer. Residents spoken with said they enjoy outings off site but they do not happen very often at present. The deputy said this was due to a lack of drivers in the current team. It is recommended this be taken into account when recruiting new staff. The home has access to a vehicle that accommodates one wheelchair user ands also a minibus shared with other homes on site. Annual holidays are planned with the residents and last year to two different holidays took place. The holiday folder shows that there is an excellent process for planning and managing resident holidays, with holiday questionnaires and information, risk assessments, ID cards and holiday care plans. Staff support residents to vote if they choose. Transport is arranged for residents who wish to attend church each week. A Baptist minister visits monthly. Residents confirmed that they are helped to keep in contact with relatives and friends. There is a private phone for residents to use. Recorded information shoes that there is low cost visitors accommodation on site for families who need this. A recommendation to further facilitate befrienders, volunteers and advocates to increase residents’ contact if they choose, has been carried out. Two volunteers come to the house weekly and some residents have advocates or befrienders. The home has also made contact with an advocacy agency to develop this further. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 14 Residents’ main meals are provided from a main kitchen on site and delivered on a hot trolley to the homes kitchen. Weekly menus are sent to the house and staff sit with residents to help them choose. A catalogue with photos of relevant meals is available to help residents visualise the choices. Breakfast is prepared in house with a cooked alternative provided on Sundays. Residents were mostly complimentary about the food provided but some said that sometimes it is not cooked properly. In further discussion they said that on some occasions vegetables are undercooked and too hard or the meat too tough for the elderly resident group. The managers are aware of this and liaise with the main kitchen regarding any problems. The residents set the mealtimes and have chosen an early supper at 4.30pm. They confirmed that they have a mid evening milky drink and snack, so are not hungry in the night. Meals are served in the dining room and it was seen that staff assist those who need help. Special diets or feeds are also provided. The kitchen was very clean. Daily, weekly and monthly cleaning rotas make sure it is regularly cleaned. The deputy confirmed that all staff have received food hygiene training. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents care needs are met in the way that they choose. They have good access to heath care professionals. Staff are trained to give medication safely. EVIDENCE: The care files for three residents were seen and contain well organised and clear information about residents preferred routines and how they like their personal care needs to be met. Residents are involved in setting up their care plans and reviews. Cross gender care preferences are well documented. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 16 Residents’ files sampled show that their health care needs are identified and met. Health records seen were well kept. There are records of their contact with health professionals, some of who are based on site and others who are based in the wider community. There are clear guidelines in place to support behaviour or health needs and the professionals involved sign up to these. There are monitoring charts for specific health needs. A previous requirement that all staff comply with the homes medication policy and make sure that codes are used for times when residents are on holidays and when creams are used has been met. The medication system was seen and storage and administration was found to be satisfactory. As recommended at the last inspection risk assessments have been carried out and some residents have now chosen to self medicate. Appropriate arrangements are in place to ensure safety and the monitoring of this. Guidelines regarding medication to be given when needed have been signed by the relevant health professional. Records show that staff receive medication induction and training. Feedback from health and care professionals surveyed was positive, meetings with me are always dealt with respecting (the residents) privacy and dignity. this is a nice home with caring staff. All service users have a range of medical needs and these are the services top priority. ‘ (Staff are) empathetic, passionate about their clients, loving and caring, homely environment. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know that their concerns will be dealt with. Staff know how to protect residents from abuse. EVIDENCE: The Commission has not received any information about complaints made about the service. In discussion with staff and in speaking to residents it was clear that concerns are dealt with promptly. One resident said that they would speak to the manager or keyworker and knew they can have an advocate and how to contact them. Resident surveys show that they know who to talk to if they have a concern. The complaints policy is accessible to service users in the Service Users Guide and is on notice boards in the lounge and dining room. Staff spoken to were familiar with the Complaints procedure and where the Complaints Record is kept. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 18 The Commission has not received any information about any Safeguarding Adults issues occurring in the home. Staff training records show that staff have received Protection of Vulnerable Adults training. Staff spoken with were aware of the procedure and who to report any concerns to. The home follows the local interagency procedure. Residents’ files identify their cross gender care preferences and care guidelines are in place to support these. There are systems in place to protect residents’ finances and an independent financial audit of the home was carried out 21/01/2008. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from accomodation that is clean, well maintained and homely. Planned redecoration and refurbishment will further improve their accomodation. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 20 EVIDENCE: A tour of the home showed that it is clean and well maintained. Residents bedrooms are well furnished and are personalised according to their taste. A previous requirement to make sure the home is well maintained, homely and safe has been met. Redecoration of the entire home is planned for February 2008. Residents said they have been involved in the choosing of new colours for their bedrooms and the communal areas. Staff had painted samples of colours on large wallpaper samples to help residents choose. Bedroom 5B has been decorated as required from the last inspection but will be redecorated again as part of the refurbishment of the home. Corridor carpets have been replaced with washable wood effect vinyl flooring. Storage boxes have been purchased for residents personal care items. New garden furniture has been purchased. Bathroom doors are fitted with an adaptation, made on site, to hold the doors slightly ajar to enable monitoring of residents with epilepsy. At the last inspection it was required that they be removed and doors fitted with an appropriate lock to make sure residents cannot accidentally be locked in and to ensure privacy. This has not been done yet; the deputy manager demonstrated the need to retain these devices and showed that it is not possible to accidentally lock a resident in. Risk assessments should be in place for all residents who need monitoring during bath times. These should demonstrate that there are no risks from the type of device being used or and that residents privacy is not compromised. Risk assessments should be regularly reviewed with residents, their relatives and care managers. It is recommended that the registered person investigate whether a more suitable monitoring solution is available. There is suitable equipment in place to help those with restricted mobility. These include wheelchairs, hoists and assisted baths. As required at the last inspection risk assessments are inn place regarding the safe use of wheelchairs and a new custom built wheelchair has been purchased for a resident who found using footrests difficult. Discussion with staff and training records show that they have received training in Infection Control. There is appropriate equipment for washing soiled laundry and the disposal of clinical waste. Residents confirmed that the home is always kept clean and hygienic. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by enough staff who are trained to meet their needs. Residents are satisfied that staff treat them well and listen to what they say. A robust recruitment procedure helps keep service users safe. EVIDENCE: A requirement that the proprietor and manager must ensure that staffing levels are reviewed to fully meet residents needs has been met. An extra staff member is now deployed on the afternoon shift. The deputy manager said that the additional staffing needs of one resident were re-assessed but he is no longer in the home. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 22 The majority of staff training happens on site and the deputy manager and staff said that this works well. The team-training plan shows training undertaken and courses that are booked. Records show that staff have a full induction and mandatory training. A staff file was sampled and contained verification of induction and training carried out. The home has a programme of National Vocational Qualification (NVQ) training underway. The home has not yet met the target of 50 of staff trained to NVQ level 2 and above but is working towards this. Two staff have achieved NVQ level 4, one has level 3 and another is taking this, three have level 2 and two are booked for this. The Recruitment Policy shows that there is a robust recruitment procedure in place. This includes carrying out Criminal Records Bureau and Protection of Vulnerable Adults list checks, employment history, visa/permit to work status and references. Staff spoken to confirmed that the procedure had been carried out. As recommended at the last inspection team meetings are now held. Staff spoken with said that there is good communication in the team and that they work well together. The staff team at Milton house is mixed culturally and staff and managers were positive about what this has to offer. Staff spoken with said there was good morale in the team and some feel that the organisation can offer them a positive career path. There is a system of regular staff supervision in place and this was confirmed by records and speaking to staff. Feedback about staff from residents was positive, the majority said that staff treat them well and always listen to what they say. Feedback from health professionals about staff was positive, the staff are always attentive to their needs and (the home is)very ably managed by Mary Hooba whom I can’t praise enough Staff are very person centred in relation to any requests, differences etc brought to their attention. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39,40, 41 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and residents views are sought to help develop the service. Health and safety systems keep residents safe. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 24 EVIDENCE: The AQAA (Annual Quality Assurance Assessment) received from the home prior to the inspection, was well completed and gave good information about how the home meets the standards. It shows clearly where the evidence is kept in the home so that it would be accessible to be inspected if the manager or deputy were not on duty at the time of the inspection. The AQAA states that the registered manager has many years experience in working with the client group at a senior level. She is a trained nurse who has also achieved the Registered Managers Award. It also confirms that the manager regularly updates her knowledge and skills. At the time of the inspection the manager had returned that day from long-term sick leave. In the interim the deputy manager was carrying out the acting manager role and there is evidence that the home has been well managed during this period. The deputy manager has achieved NVQ level 4 and has received other relevant training. Since the last inspection all of the requirements and recommendations have been addressed and the systems in the home have been well run. Staff spoken with said that managers are accessible and take their views into account. There is a system for seeking the views of residents and staff. Annual surveys take place and are used to develop the service. it is recommended that the organisation consider including the views of other stakeholders in this survey. A member of the Board of Trustees carries regulation 26 visits out monthly. Copies of these are held in the home. These were sampled and show that they meet the regulation. Annual reviews are held to review residents’ needs and reflect the aims and outcomes for individual residents. House meetings have been developed so that residents can contribute to the running of the home. The home operates in accordance with policies and procedures of the National Centre for Epilepsy and copies are kept in the home. Some of these were sampled during the inspection and were accessible and appropriate in content. During the course of the inspection records relating to care, staffing and health and safety were sampled. These were well organised, accessible, well written and up to date. Only one health and safety record needs improvement and is highlighted below. The home operates in accordance with the organisations health and safety policies and procedures. Staff are trained in safe working practices and staff records sampled showed these include moving and handling, fire awareness, food hygiene, health and safety, Protection Of Vulnerable Adults, and health and safety. Records show that regular checks and servicing are carried out to Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 25 essential equipment. Health and safety records were sampled and the majority were satisfactory. The record of water temperature checks to hot water outlets accessible to residents must be reviewed to make sure that staff take action and record this when temperatures are too high. The organisation carries out a health and safety audit annually and there are comprehensive health and safety risk assessments in place. The deputy manager said that there are plans to carry out a three monthly in house health and safety audit. A health professional survey said Safety and reliability is the services strongest point. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable Health professional survey Safety and reliability is the services strongest pointCHOICE OF HOME Standard No 1 2 3 4 5 Score CONCERNS AND COMPLAINTS X 3 3 3 3 Standard No 22 23 Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 3 39 3 40 3 41 3 DS0000022999.V358229.R01.S.doc Version 5.2 Page 27 LIFESTYLES Standard No Score 11 3 12 3 13 2 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 Milton House Score 3 19 20 21 3 3 X 42 43 2 X Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA32 Regulation 13 Requirement The registered persons must review the record of water temperature checks to hot water outlets accessible to residents, to make sure that staff take action and record this when temperatures are too high. Timescale for action 21/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA2 YA13 YA24 Good Practice Recommendations The section about dietary requirements in the admissions assessment should include a prompt about cultural dietary needs. It is recommended that the homes lack of drivers be taken into account when recruiting new staff It is recommended that the registered person investigate whether a more suitable monitoring solution for bathroom doors is available. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Milton House DS0000022999.V358229.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!