Care Home: Milton Lodge

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What the care home does well The home carries out thorough assessments and obtains good information before people are admitted to the home. Admissions take place over a period of time to help ensure the person`s needs can be met and to make sure they interact well with other people living in the home. There are good systems in place to help ensure people`s opinions are listened to and they are encouraged to be involved in the day to day running of the home. The staff receive good training to meet the individual needs of the people they care for. There are very good arrangements in place to support people to access educational and recreational activities. A gardening project has been set up where people can grow their own vegetables, herbs and flowers. They also keep chickens, rabbits etc. Two people said they enjoyed every minute they spent there. People are supported to take part in community based activities of their choice and they are well supported to keep in contact with family and friends. People are encouraged to learn daily living skills and independence is encouraged. The staff monitor people`s physical and emotional health and make prompt referrals to health care professionals when necessary. The management meet with people living in the home and the staff on a regular basis to listen to their opinions and concerns so action can be taken if improvements are necessary. Comments from staff included: "A good company meeting everyone`s needs". "It`s great I love my job". "I have worked here for nearly 6 years and totally love my job". What has improved since the last inspection? A new kitchen has been installed. A new cooker and washing machine have been purchased. A detached conservatory has been provided which is used as a smoking room. A refurbishment and maintenance programme is in place. What the care home could do better: No requirements or recommendations were made at this inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Milton Lodge 23-24 The Esplanade Whitley Bay Tyne & Wear NE26 2AJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anne Brown     Date: 2 9 0 7 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: Milton Lodge 23-24 The Esplanade Whitley Bay Tyne & Wear NE26 2AJ 01912533730 F/P01912533730 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) : Mr Alastair Craig Nurse care home 13 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 13 13 The maximum number of service users who can be accommodated is: 13 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, maximum number of places 13, Learning Disability - Code LD, maximum number of places 13 Date of last inspection Brief description of the care home Milton Lodge is situated in the centre of Whitley Bay and is close to the sea front, shopping centre and transport systems. The home is divided into two units and provides care for male service users, aged 18-65 years old. The accommodation is over three floors and there are thirteen single bedrooms. There are three lounges, two dining rooms and a patio area to the rear of the premises. The home does not provide nursing care but is registered to provide personal care and support to people with learning disabilities and/or mental health problems. Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home The fees start from £382.51 per week and are dependant on individual needs. Inspection reports and information about the home are readily available. 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means that the people who may use this service experience excellent quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out Care Homes for Adults (18-65 years) Page 6 of 29 Before the visit: We looked at: Information we have received since the last inspection on 21st August 2007. Any changes to how the home is run. The providers view of how well they care for people. Surveys returned from people living in the home and the staff. An unannounced visit was made on 28th July 2009. During the visit we: Talked to the manager and staff on duty. Looked at assessment information about the people who use the service and how well their needs are met. Looked at some policies and procedures. Looked at staff training programmes. Looked at the homes recruitment and selection procedures. Looked around the premises to make sure they were clean, safe and comfortable. We told the manager of the home what we found. What the care home does well: What has improved since the last inspection? What they could do better: No requirements or recommendations were made at this inspection. Care Homes for Adults (18-65 years) Page 8 of 29 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. There is good information available about the home and thorough assessments are carried out over a period of time to help ensure individual needs can be met. Evidence: The statement of purpose and service user guide both contain the full range of information required. This helps people decide if the home is able to meet their needs. The documents had been reviewed on 1st July 2009 and were on display in the hallway. The home carried out thorough pre-admission assessments. This includes obtaining a care management assessment and information from relevant health care professionals. Copies are available on the individual case files so staff can refer to these to help ensure individual needs are met. People spend time in the home before deciding to move in on a permanent basis. The home provides a phased admission which ranges from twelve weeks to six months Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: which gives the management and staff time to fully assess peoples needs. It also helps ensure the person fits in and interacts well with the other people living in the home. 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. There is good information available to the staff to help them support people according to their preferences. People are consulted and make decisions on all aspects of their lives. Evidence: The care plans give detailed information to staff on how care and support should be delivered for each individual living in the home. People are encouraged to become involved in their care plans so they can be supported according to their preferences. The care plans are updated every three months or earlier if peoples needs change. The home supports people to remain independent and take risks in order to live a more fulfilled lifestyle and up to date risk assessments were present in the care records. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: Each person living in the home is consulted about decisions concerning their own lives and the day to day running of the home. Two people said they made decisions about what they wanted to do every day. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are very well supported to attend both educational and recreational activities of their choice and they are able to access facilities in the local community. Evidence: People choose where they would like to go socially and have a personal plan which reflects what they have chosen to do each week. Some people attend courses at a local college. These include computers, cookery and photography. Two people attend a day placement at Norcraft which is a workshop where they restore and make new furniture. The service has recently developed a farm base where people are supported to grow vegetables, herbs and flowers. There is a poly tunnel to grow the plants and they Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: intend to erect another in the near future. They also keep chickens, rabbits and ferrets. Two people said they enjoyed every minute of the time they spent there. They were very proud of their achievements and their produce. One person said they came to the farm on their bicycle at weekends to look after the animals. They also provide a gardening service, mainly for older people. They manager said the people living in the home really enjoy this. Two people living in the home were looking forward to completing the Cheviot Challenge, a 25 mile walk through the Cheviots. They said they were going for a practice run this weekend. Two people have bicycles and have completed a cycling proficiency course to help ensure their safety Other people enjoy fishing and had enjoyed two weekends away recently. Trips are planned on a regular basis either in groups or individually according to peoples choice. These have included trips to Leeds Market, Sunderland Air Show and York. Other activities include swimming, gym, cinema, shopping, visits to local cafes and pubs. One person is visited at the home by his mother and another has a friend who visits. Other people are supported to visit their friends and families in the community. People are able to keep small pets if they wish. These include budgies, parrot, hamsters and tropical fish which people care for themselves. The home has two mini buses and a people carrier to escort people to activities of their choice. They also use public transport when appropriate. Mealtimes are flexible according to peoples routines. Four weekly menus are in place and alternatives are always available. Healthy eating is encouraged and two people are on weight reducing diets. 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. The people living in the home are provided with personal support when they need it and the staff monitor and promote their health needs to maintain their well being. Evidence: The people living in the home are registered with a GP of their choice as far as this is possible. They are supported to attend health care appointments and these are fully recorded in their individual case records. The staff have clear guidelines on how to meet individual health care needs and make prompt referrals to health care professionals when necessary. People aged 50 years and over are encouraged to have a well person check at their local GP surgery. People are advised about other services their GP surgery has to offer, e.g. dietician, smoking cessation classes etc. The staff have received training on how to meet the individual needs of the people living in the home. If personal care is required this is provided by staff of the same Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: gender in order to maintain peoples dignity. The medication records were up to date and appropriately signed. The staff have received external training in the safe handling of medicines and are supervised within the home until they are assessed as competent. People living in the home can retain their own medications if they are assessed as capable. 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. There is an appropriate complaints procedure in place which people are aware of and staff have received training on safeguarding vulnerable adults, which helps to protect people from abuse. Evidence: The home has an appropriate procedure for dealing with complaints. A complaints log is kept to record any complaints and the outcome of the investigations. No complaints have been received since the last inspection. People living in the home said they knew how to make a complaint. The staff were aware of the procedure to follow if any concerns were raised. All staff have received training on safeguarding vulnerable adults. This training is currently being updated. The manager is well aware of the procedure to refer any issues regarding safeguarding to the local authority. People are encouraged to manage their own finances if they are assessed as being able. If not their personal allowances are held by the home. The records that were examined showed that transactions are fully recorded. Receipts are kept for any Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: purchases made and two staff signature are maintained. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and comfortable and provides people with a pleasant place to live. The bedrooms reflect the individual tastes of the people who live there. Evidence: The home is clean and comfortable and provides people with a nice environment to live in. There is a choice of communal areas. A detached conversatory has been provided as a smoking room. As the home is rehabilitative it teaches people new skills or helps them to relearn previous skills, therefore some people are involved in the cleaning of the home. All the people living in the home are expected to clean and tidy their bedrooms with assistance from staff if necessary. Systems are in place to ensure that a good level of hygiene and cleanliness are in the home to ensure the health and safety of everyone. Each person has their own bedroom. These are personalised and reflect the interests and hobbies of each individual. A maintenance and renewal programme is in place. Since the last inspection a new kitchen has been installed. A new cooker and washing machine have been purchased. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: The dining room has been redecorated and provided with breakfast bars and new chairs which were chosen by the people living in the home. New flooring has been provided in the downstairs hallway, dining room and upstairs corridor. Policies and procedures are in place to help prevent the spread of infection. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff employed in the home who are well trained to meet the individual needs of the people who live there. Evidence: The home employ 24 care staff. On the day of the inspection the manager, deputy manager, team leader and seven support workers were on duty. The manager stated that thirteen staff have achieved a National Vocational Qualification (NVQ) Level 2, four have achieved Level 3 and two have achieved Level 4. All other staff are currently enrolled for Level 2. A support worker has recently been promoted to deputy manager and is currently undertaking NVQ Level 4. There are training programmes in place to ensure staff receive mandatory health and safety training. Other training is specific to the needs of the people living in the home. The manager stated that they try to recruit staff who have similar interests to the people they care for which helps to form good working relationships. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Staff morale is good. Comments included:I have worked here for nearly six years and totally love my job. Its great, I thoroughly enjoy it. A good company to work for. There is a robust recruitment and selection procedure in place. Criminal Records Bureau checks and two written references are obtained before people are employed in the home. This helps to protect people living in the home. The manager stated that new staff are not left alone with people for at least three months. They are then assessed to ensure they are competent within their role. Supervision sessions are carried out with all staff at appropriate intervals and written notes are made. The staff felt they were well supported. One commented I work very well with management and know that if I ever have a problem they are very easy to approach. All staff are issued with the General Social Care Council code of conduct and this is explained to them as part of their supervision. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The culture and systems in the home help to ensure that the service is led by the needs and wishes of the people living there, and protects them from harm. Evidence: The registered manager has worked at the home for some years. She has completed the Registered Managers Award. Discussion and observation maintain that she puts the needs of the people living in the home first and promotes an ethos amongst staff of involving everyone in decision making within the home. The management has an open door policy for staff and the people living in the home. They spend time every day listening to any concerns or suggestions people may have. The manager said she sometimes takes people on an outing which gives them private time to discuss any issues they may have. Each person living in the home meets with a member of the Community Learning Disabilities Team on a weekly basis. They can discuss any concerns they may have and Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: their plans for the following week which ensures arrangements can be put into place. The home act on feedback received from relatives and external professionals who visit the service. They try to support people to achieve their goals and ensure individual wishes are met where possible. Good relationships exist between the management, the people living in the home and the staff. Staff meetings are held on a regular basis and detailed minutes are kept on the items that are discussed. There are comprehensive policies and procedures in place to safeguard the rights and best interests of the people living in the home. All records that were examined were well documented and up to date. The records showed that fire drills are carried out and fire equipment is checked on a regular basis. The staff receive regular health and safety training. 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 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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