Care Home: No 3 Milton Heights

Similar services:

• Hillview Farm
• Dalewood Respite Care
• Orchard,The
• REACH Upton Court Road
• Fairways
• Treloar College
• Kestrel House, St Anne`s Opportunity Centre,
• Pinta

What the care home does well Everyone who lives here has a ‘person centred plan’. This means that staff know each person well and how they like to be supported and the kinds of things they like to do. There are lots of things for people to do and they can choose different activities with the help of the staff in their house. The people who live here have their own rooms that are comfortable and clean and where they can choose the colours and furniture they want. There is lots of space outside to go for walks or runs and enjoy the garden. What has improved since the last inspection? This was the first time we have visited number 3 Milton Heights. Because new rooms have been built and new doors and a wide sloping path has been madeNo 3 Milton HeightsDS0000073042.V375132.R01.S.docVersion 5.2from the garden to the sitting room, we can see that this has made the house much better for the people who live here and easier to get around. What the care home could do better: The home is well run. The manager and staff are always thinking about things they could do better – like using computers and DVDs more to make things easer to understand and share ideas between staff and the people who live here. So we know that the home is already working on some of the things that could be better and we look forward to seeing these new changes when we next visit. The hot water to the bath in one person’s bathroom was too hot and could have hurt them. The manager quickly took action to make sure the water was made less hot. We think the home should make sure the hot water is always at the right temperature and should test it regularly. Sometimes things get broken in the house and the manager has to get someone in to mend them. We think that it would be good to write down the date when staff report when something is broken and how long it took for the person to come and mend it. This would show that things get fixed as quickly as possible so that people living here know that everything is safe to use. Key inspection report CARE HOME ADULTS 18-65 No 3 Milton Heights HFT Milton Heights Potash Lane Milton Heights Abingdon Oxfordshire OX14 4DR Lead Inspector Delia Styles Unannounced Inspection 7th May 2009 15:20 No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service No 3 Milton Heights 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) HFT Milton Heights Potash Lane Milton Heights Abingdon Oxfordshire OX14 4DR 01235 827615 HFT Registered Office Mrs Lisa Jayne Faulkner Care Home 3 Category(ies) of Learning disability (0) registration, with number of places No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 3. Date of last inspection N/A Brief Description of the Service: No 3 Milton Heights is one of five registered homes in Oxfordshire managed by Home Farm Trust (HFT), a national voluntary organisation that provides care services for people with learning disabilities. There are seven houses and four flats at Milton Heights. These provide accommodation for groups of between three and nine people, with thirty-nine in total. The houses are set in a Close within large grounds. No 3 is a large detached house providing upgraded and adapted accommodation for 3 people and newly registered with the commission in November 2008. Local facilities in the nearby towns of Abingdon and Didcot are within easy reach and people are supported to access these by use of the house vehicles and public transport. A Day Resource Centre on site offers activities such as computers, cooking, photography and pottery. There is also a coffee shop and craft store and large organic garden with a greenhouse on site. Milton Heights provides a range of daytime activities, learning and work opportunities for the people who live here and for people living in the community. The fees charged for this service are individually set depending on the level of peoples agreed assessed needs. No 3 Milton Heights DS0000073042.V375132.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. This is what the inspector did when she was at the home. The visit lasted for just over 3 hours on a Thursday afternoon. The inspector looked around the house and saw all the new things that have been done to the rooms and the changes that have been made to make it easier for people to get around inside and outside. The inspector met 3 people who live here and talked to one person who lives here. They showed her their room and the folder and pictures that tell staff about what they like to do and how they like staff to help them. The inspector looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. The inspector talked to the manager, Lisa Faulkner, and a team Leader and other staff about what sort of things the support workers do to help people to go to day centres, shopping, and other interesting things that they like to do. What the service does well: What has improved since the last inspection? This was the first time we have visited number 3 Milton Heights. Because new rooms have been built and new doors and a wide sloping path has been made No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 6 from the garden to the sitting room, we can see that this has made the house much better for the people who live here and easier to get around. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s individual needs and aspirations are fully assessed with the involvement of the individual as far as possible, and their family and advocates so that they can be confident that the home will support them in their chosen lifestyle. EVIDENCE: The home has not had any changes in the service users who live here. There are currently 2 men and 1 woman all of whom have lived at Milton Heights for several years. The manager said that should a vacancy arise, prospective service users and their families are given information about the service provided. This would include information about House 3, the staff, the support worker system and the way support is provided. A comprehensive assessment is done prior to someone coming to live here to ensure that the service can meet the needs of the individual and that the individual is appropriate for the service. This is completed with the potential resident, their family members, care managers and health care professionals and any other advocates and representatives for the person. Assessment of needs and support is a continuous process to ensure that the service continues to support the needs of the individual. Home Farm Trust uses No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 9 a computerised assessment and recording tool - Support Planning and Recording System (SPARS) - that provides detailed and up to date information about the people living here and how they need to be supported. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives and play as active a role in planning the care and support they receive as they are able. Staff support individuals to lead purposeful and as independent lives as possible, according to their abilities. The person centred care plans accurately reflect the individual’s personal preferences and aspirations. EVIDENCE: All service users have an individual Person Centred Plans (PCP), individual support Plans and/or Life stories, written in a variety of mediums. PCPs include all aspects of service user’s lives including health, physical, social, emotional, spiritual and intellectual. The service users are at the centre of this process and are encouraged to explore new opportunites and develop skills and interests. Plans are reviewed, monitored and evaluated and updated to reflect changes in the individuals needs or wishes. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 11 One person showed the inspector their assessment and Person Centred Plan (PCP). This showed that individual support plans are developed with, and owned by the person using the service and that the individual is supported with opportunities to try new leisure activities and meet new people. The person has contributed to their ‘folder’ and is familiar with the contents and that it describes how they want to be supported in their day-to-day life and routines of the home. From talking to the manager and staff, and from our knowledge of the ethos of Home Farm Trust, it is evident that the staff are fully committed to supporting individuals to lead as purposeful and fulfilling lives as possible. Each person’s file has completed risk assessments covering a wide range of risk and hazards such as personal health – (for example, seizures, for residents with epilepsy), household and environmental hazards, such as access to the kitchen and hot surfaces. Some of the risk assessments had been drawn up for the house that people had lived in during the time taken to complete the building and refurbishment to No. 3 Milton Heights. The manager confirmed that the risk assessments had been reviewed since people had moved back into No. 3 house and were still relevant. The homes Annual Quality Assurance Assessment tells us that the organisation is reviewing their risk assessment process to incorporate the ‘best practice’ guidance reflecting the Mental Capacity legislation, so that people living here are empowered to make choices but risks are managed realistically for each person. Staff have received comprehensive training in the use of the SPARS assessment and goal recording, and in computer use, to ensure that the care plans are kept up to date and accurately reflect the current needs of the people who use the service. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff support individuals to lead purposeful and independent lives and ensure that care plans accurately reflect the individual’s personal preferences and aspirations. EVIDENCE: People living here attend sessions they choose at day services and staff support them to attend non-day services based on activities of their choice throughout the week, weekend and evenings. For those individuals for whom going into different environments and meeting different people is stressful, staff ensure that they have the opportunities to build up their confidence and adapt gradually to new experiences and stimuli. The manager and staff said that the move to temporary accommodation whilst the building work had been undertaken in No. 3 had been a challenge, both to service users and staff, but that the experience had been valuable in No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 13 developing staff and residents’ relationships and the confidence and skills of the people using the service. People have their individual daily activity diary that shows how they will be supported by staff to be involved in activities that they enjoy and that interest them. The routines and activities are very flexible and are adapted to reflect people’s different needs and abilities. Two people living here attend day services off site. The home has mini buses that can be used to transport people to local shops and facilities. The home actively supports contact between residents and their family through regular visits or phone calls. This enables open communication and working together. Home Farm Trust offers a family/carer support service for interested or existing families to access as required. Two residents regularly go home to their family for weekends. The manager said that the food shopping for the house is done weekly. There are always choices available if someone does not like the meal on offer and staff encourage healthy food choices. People are helped to choose and indicate their favourite menu choices through use of pictures of different dishes or being shown what is available. Staff are aware of individual’s likes and dislikes from their assessment information and checking with them on a daily basis. On the day of this inspection visit, the evening meal was pan-fried liver and onions, with mashed potatoes. The kitchen is clearly a popular ‘hub’ of the home and residents gathered to watch the meal being prepared by care staff. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. 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. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 who live here receive the personal, physical and emotional support to the level they need and that meets their preferences. Service users are supported to access any NHS healthcare services needed, so that they stay healthy and well. EVIDENCE: Information about people’s personal support needs and preferences are set out in detail in their PCPs. House 3 actively involve other professionals or external resources where necessary to assist with the changing support needs of individuals. For example, additional occupational and physiotherapy advice and treatment is in place for one person. The manager said that the local GP surgery is very good and the GP will visit the home to see people. Most of the staff working at the home have worked here for a long time and so have got to know the peole using the service well, and are sensitive to their needs and how they express these. Each person has a ‘key-worker’ who is responsible for ensuring that information relating to the individual’s particular likes, dislikes and needs are No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 15 communicated to all other staff. The manager explained that if agency staff are needed to cover some shifts, the same staff are requested from the agency. All agency staff have an induction and detailed handover, including how to access the support plans for the people living here. This means that each individual is able to receive the support they need and there is minimal disruption to their routines. Some individuals at the home have specialised health needs, for example, epilepsy. The home ensures that staff members are trained to respond to medical and health emergencies. Records showed that assessments include a range of community health care professionals so that appropriate mobility aids and equipment have been provided to encourage and maximise people’s independence. The home environment has been adapted to meet the physcial support needs of an individual so that they can independently access all the communal areas of the house. The house has clearly written policies and procedures about the storage and administration of medication. There are also printed information sheets with the MAR charts to inform staff about the purpose of each person’s medication. Staff training schedules and the sample of individual staff records seen showed that staff receive training from the supplying pharmacist and also from an external training organisation about safe management of medication. Each person’s medicines are kept in locked cabinets in their rooms. Staff administer prescribed medication. One resident is supervised to take their medication from the monitored dosage cassette. Staff maintain a record of the medication given and this is stored in a locked cupboard and taken to the resident’s room when they take their medication. The medication adminstration records (MAR) seen at the time of the inspection were up to date with one exception, where two evening doses had not been signed for by the staff member on duty. The manager said she would follow up this oversight with the staff member concerned. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 practices and procedures of the home and the organisation protect service users from abuse and exploitation. EVIDENCE: HFT has clear polices and procedures for complaints and ‘whistle blowing’ which have been made accessible to service users and staff by providing and explaining it in a user friendly format. HFT has sound financial management systems in place that protect service users from financial exploitation or abuse. Managers receive training in all aspects of this and are monitored and supervised via area managers. HFT has internal audit inspections every year with detailed action plans which are implemented. The manager explained the system of safeguards and checks in place to make sure that any money held on behalf of service users is accounted for. Two staff check the cash balance at the end of each shift to ensure that household expenses and receipts (for example, shopping) tally – this was seen on the day of the inspection. People living at No 3 are not able to verbalise concerns and so may be less able to take part in the regular meetings or ‘speak out’ groups that service users at Milton Heights hold, where people are encouraged to say when things are not right or they have any concerns. However, each service user has a key worker who gets to know them very well and who is alert to pick up on any No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 17 changes in their mood or behaviour that may indicate that they have a problem. Families are also encouraged to share any concerns or complaints and these are responded to by either the unit manager or the service manager. HFT regularly monitors complaints and how they are managed through their quality management and auditing tools. There have been no complaints received about this home to date and the commission has not been made aware of any concerns. The AQAA states that staff receive regular training in adult safeguarding issues (‘Abuse Awareness’) and this was verified from the sample of staff training records looked at. Notifications made to the commission about action taken by HFT in relation to staff disciplinary matters show that the organisation has acted promptly and appropriately when it has received (rarely) allegations of poor practice or abuse by employees. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 who live here have a safe, clean, well-maintained and comfortable home that suits their individual lifestyles and preferences. EVIDENCE: A tour around the home showed that it has been adapted and upgraded to meet the diverse needs of the people living here. The communal area of the home (the large lounge cum dining room) is sparsely furnished. The manager explained that this is to enable people to gradually adapt to and accept the new environment, furniture and décor. A sloping path with a handrail has been added to provide access from the garden to the lounge area through sliding double glazed doors. The inner pane of glass in one door had a crack across its width. The manager said this had been reported and a new glazed unit was on order. It was not felt to be a risk to residents using the door meanwhile, as the glass is safety glass and secure in the frame. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 19 The adaptations made in the house have meant that an individual with physical disabilities can get around the house and go outside to the garden independently. Two of the three residents’ bedrooms have en-suite facilities that include a shower, toilet and sink, with the third having a designated bathroom next to the bedroom. All the upstairs bedrooms have window restrictors and the radiators can be thermostatically controlled. All radiators have low surface temperature covers and the bedrooms have lockable storage facilities. The kitchen and laundry room are fully equipped with new appliances that meet the required standards. The induction cooker hob surface cools instantly to reduce the risk of injury to service users. The home is clean, fresh smelling and light. Some minor ‘snagging’ work is still to be done to the new parts of the building, for example, around doorframes, but the manager said this is in hand. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support workers are appropriately trained and employed in sufficient numbers to support the people living here in a way that allows for flexibility and fits in with service users individual lifestyles. EVIDENCE: The staffing levels are two for the morning shift, two for the afternoon and evening, plus a floating member of staff throughout the day, and two sleepingin staff overnight. Staffing shift patterns are flexible so that staff are available to support service users in the different activities they want to do – for example, going out to evening activities, day services and shopping outings. A staff training matrix and record of supervision dates evidenced that there is a good programme of training and development in place for staff. The manager confirmed in the AQAA that all new staff have an induction pack that meets the Skills for Care (national approved training body) standards. Each staff member has an individual training plan that is developed and monitored through supervision and annual appraisal system. HFT has designed a ‘professional passport’ setting out what is expected within each person’s role through the use of a ‘capability’ matrix. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 21 Mandatory training includes Health and Safety, Risk Assessment, Moving and Handling, Food Hygiene and First Aid. All staff attend refresher training in these topics every 3 years. In addition, staff have training in any specific topics required – for example, about epilepsy and understanding autistic spectrum disorders. All staff have had IT training and have access to a computer and the Internet so that they can use the SPARS computerised record system. Staff are offered the opportunity of completing a National Vocational Qualification (NVQ) once they have successfully completed their induction and probation. Four of the seven permanent care staff have the NVQ Level 2 or above in Care or Health and Social Care. This means that the home has achieved the expected 50 percentage of staff who have an NVQ Level 2. All staff in the home understand the aims and purpose of the support they offer. They are consulted regularly via staff meetings and regular supervision and appraisal. HFT offers an incentive scheme to recognise and reward extra effort and contributions to service development. An example of this was seen in the sample of staff files examined – a staff member had a commendation for their work during the period when everyone had to move to different accoommodation whilst the building work and upgrading of No 3 Milton Heights was done. The recruitment and training files for 3 recently appointed support staff were inspected. These showed that the recruitment procedure is thorough and that the required pre-employment checks, references and selection process safeguards service users from unsuitable workers. The AQAA tells us that the home has experienced some recruitment difficulties and that has resulted in a higher use of agency staff than they would wish. However, they have worked with the agency provider and provided induction training for agency staff so that there is consistency and continuity of support for people using the service. The manager and administrator confirmed that recruitment drives have been successful and are optimistic that the staff team will continue to reflect diversity, with a mixture of full and part time staff, male and female, and from different cultures and backgrounds. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. 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 home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 well managed by a competent person and a staff team who listen and act on the views of service users and their families and advocates, so that all work together to improve the quality of life for the people living here. More attention should be given to the systems for monitoring the maintenance and safety of the environment. EVIDENCE: The registered manager has the required qualifications and experience and is competent to run the home and meet its stated aims and objectives. She has completed the Registered Managers Award and NVQ Level 4 in Care and the homes AQAA tells us that she has undertaken a range of management training to maintain and update her skills in her role. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 23 An HFT service manager does monthly ‘Regulation 26’ provider visits to get service users and staff views about their homes and any improvements they would like. The assistant service manager was visiting Milton Heights on the afternoon of this inspection visit, and clearly has a good understanding and knowledge of the care and support needs of the people using this service. HFT has recently reviewed its quality assurance (QA) system – ‘to be more person-centred’ using key quality of life indicators that indicate how well it is meeting peoples needs through: ‘Care, Consultation, Communication, Opportunity, Respect and Empowerment’. In addition, HFT carries out an indepth quality review of each individual’s care and support – there are two of these reviews per service each year. It is evident that the organisation has comprehensive policies and guidelines in place to ensure the safety ad wellbeing of residents. The annual audit and report of each service carried out by HFT’s Health and Safety manager highlights actions and recommendations that are to be carried out. However, No 3 Milton Heights is a new registration and we consider that some improvements need to be made to the day to day monitoring and reporting of damage or hazards in the home environment. The incidence of damage caused by residents and the risk to them is high as a result, because of their vulnerability and complex needs. It was noted that were some damaged fittings and furniture in 2 people’s rooms. The manager was not aware of that bottom of the radiator cover in one person’s room had been dislodged and could be a potential risk to the individual. Breakages and damage are reported to the maintenance manager on-line. We recommend that the manager and staff also maintain a paper record to evidence when breakages and damage have been reported and when work has been completed (and the timescales if there is likely to be a delay). There is evidence that the home manager and staff try to find solutions to making sure that the furnishings, fittings and equipment in the home are of a good quality and meet the diverse needs of the people living here. For example, the manager said she is researching specialist companies to find the most suitable and robust wardrobe for one person’s room that will help the individual to see and access their clothing and continue to exercise choice about what they want to wear. They are also considering adding a film covering to windows that will enable people living here to see out, but stopping people from seeing in. This will protect peoples’ privacy and dignity. The hot water supply to the bath in one person’s en-suite was tested by the inspector and found to be excessively hot - the temperature was 52°C as measured on the inspector’s probe thermometer. The manager said that this individual bathes independently, so that there is a potential that they are at risk of scalding. The risk assessment in their care file did not include reference No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 24 to regular checks of the hot water temperatures to ensure the safety of the service user. As the bath and showers are new installations, the manager was confident that temperature-limiting valves are fitted. It was not clear whether this is so, or whether the limiter to this bath was not functioning correctly. The home does not keep a record of hot water temperature checks, so staff had not noticed any variation in the hot water temperatures. We recommend that the hot water temperature at all taps accessible to service users is regularly and routinely checked and recorded, and action taken to adjust the temperature as necessary. As soon as she became aware of the problem, the manager took prompt action to get the maintenance manager and a plumber to adjust the water temperature of the water by the end of the evening of the inspection. The manager and a staff member who is the health and safety representative in the house said that all staff follow HFT’s protocol for checking bath and shower water temperatures before assisting a service user. The staff member said that one person has a bath thermometer in their bathroom that staff could use to check the temperature. The hot water temperature at other shower and washbasin outlets was checked by the inspector and found to be within the recommended safe range of close to 43°C. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 25 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. 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 CHOICE OF HOME Standard No Score 1 X 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Version 5.2 Page 26 No 3 Milton Heights DS0000073042.V375132.R01.S.doc 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. Standard Regulation Requirement Timescale for action 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. YA42 Refer to Standard Good Practice Recommendations Maintain records of hot water temperature monitoring and requests for repairs and maintenance visits. Ensure that staff are kept informed about the progress of repairs required to protect the health and safety of people living and working at the home. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 27 Care Quality Commission Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. No 3 Milton Heights DS0000073042.V375132.R01.S.doc Version 5.2 Page 28 - 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!