Inspection on 12/01/07 for H.C.S. (Enfield) Ltd (Holtwhites Hill)

This inspection was carried out on 12th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

H.C.S. (Enfield) Ltd (Holtwhites... 28/11/07

H.C.S. (Enfield) Ltd (Holtwhites... 27/10/05

H.C.S. (Enfield) Ltd (Holtwhites... 27/09/04

H.C.S. (Enfield) Ltd (Holtwhites... 09/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 H.C.S. (Enfield) Ltd (Holtwhites Hill) 221 Holtwhites Hill Enfield Middlesex EN2 8BX Lead Inspector Mr Stephen Boyd Key Unannounced Inspection 12th January 2007 11:30 H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.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 H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.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 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. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service H.C.S. (Enfield) Ltd (Holtwhites Hill) Address 221 Holtwhites Hill Enfield Middlesex EN2 8BX 020 8342 0537 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) H.C.S. (Enfield) Ltd Vacant Care Home 8 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Limited to eight adults of either gender with a learning disability (LD) who may also have a physical disability (PD). 27th October 2005 Date of last inspection Brief Description of the Service: Holtwites Hill is a care home for eight younger adults with a learning disability. Four of these are also registered for younger adults with a physical disability. The service is managed by HCS (Enfield) Ltd. The house is detached and there is a downstairs extension offering fully disabled accessible bedrooms. Two of these rooms have an en suite shower room and there is a separate disabled accessible bathroom. There are a further four bedrooms upstairs. There is a comfortable lounge, a dining area and a conservatory. Upstairs there is a small multi sensory room. The staffing of the home consists of the acting manager and a team of care workers. There are three to four care staff working on a morning and late shifts and the night shift is covered by two waking night staff. All the people who live at the home have a day activity provided either at a day centre or at the home. Currently there are no vacancies at the home. Fees charged at the home range between £800 and £900 per week. A copy of this Inspection report can be requested directly from the home or via the CSCI website (web address can be found on page 2 of this report.) H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in one day in January 2007. The inspector met with the acting manager and had discussions with three staff members. The inspector spoke with one service user and observed five other service users who were at home during the visit. A social worker who was conducting reviews was spoken with and a tour of the premises was undertaken. Various records and policies were viewed. The inspector has also received comment cards sent out prior to the inspection from eight service users, eight visitors and a care manager. What the service does well: 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 H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 6 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.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 H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Prospective service users would have their needs comprehensively assessed. EVIDENCE: The home has not admitted any new service users since the last inspection. The inspector understood that most service users had lived at the home since it opened a dozen or so years ago. Comprehensive assessments were seen on sampled service users files and these were reviewed and updated periodically. The home has an admission policy and procedure which indicated that prospective service users would undergo a planned process of admission. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users have holistic care plans reflecting their individual needs. Service users are able to make decisions about their lives with assistance as necessary. Service users have good risk assessments which support their ability to lead as independent lives as possible. EVIDENCE: A number of service user plans were sampled during the inspection. These were found to be holistic in their approach to service users identified needs. Plans were seen to be reviewed regularly with client involvement. Formal reviews of service users care takes place at least annually and these also involve service users, families and significant others. The acting manager advised that the home is moving to a system of person centred planning over the coming months. On the day of the inspection it was observed that service users were involved in their care reviews. Thus a philosophy of ensuring service users are at the H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 10 centre of decision making and planning clearly exists at the home. Service users are involved in many decisions about their day to day lives including what food to buy and eat, what activities to pursue, what to wear and when to go to bed etc. Each service user has individual risk assessments which detail how risks can be minimised The risk assessments were appropriately detailed and were reviewed on a regular basis. The acting manager has plans to change the format of risk assessments so they are easier to read. The home was also seen to have general risk assessments completed for areas of the home where risk could occur. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 11 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): 12,13,15,16 and 17 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users are able to take part in a range of appropriate activities, many of which take place in the local community. Service users have appropriate relationships within and outside of the home. Service users have their rights and responsibilities recognised. Service users enjoy a varied and healthy diet. EVIDENCE: Service users take part in a range of activities. These include: shopping, bowling, cinema and theatre trips, meals out one to one club and various holidays. Several service users attend day facilities either full or part time. Each service user has a programme of activities as part of their overall care plan. The home has a sensory room which is utilised by the service users on a regular basis. The service users go out regularly within the local community. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 12 All the current service users have contact with family and friends to varying degrees. Comment cards received from relatives/visitors were positive about the home, saying they were welcomed when visiting and could do so in private. Service users were seen to have a good rapport with staff. Staff were seen to treat service users with respect, for example knocking on bedroom doors. Service users are not subject to unnecessary restrictions or infringements of their dignity. Service users were seen to be appropriately dressed at the time of inspection. Menus seen on the day of inspection indicated a variety of food was on offer including choice of meals. Mealtimes are flexible to accommodate service users needs and activities. A service user spoken with said they liked the food both in terms of quality and quantity. Record keeping for individual food intake was seen to be good as was the recording of fridge and freezer temperatures. Service users help with shopping for food H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users receive appropriate support within the home and from a range of health care professionals. The home has an appropriate system of medicine administration which is managed well. EVIDENCE: Service users care plans gave details of how they preferred and required support. Observation on the day of inspection indicated a sensitive approach to service users care. A service user spoken with said they liked the staff and felt well looked after. Care plans and health records seen during the inspection showed that service users health needs are given a high level of priority within the home. Regular appointments with health professionals such as dentists, opticians’ chiropodists and g.p’s were seen to take place. The acting manager reported good relations with health services, although getting people weighed was a problem due to lack of suitable equipment in the locality. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 14 The home operates a monitored dosage system of medicine administration. This was checked during the inspection and found to be working well. Staff who administer medication have received appropriate training. None of the service users are assessed as able to self-administer medication. Medication was seen to be kept securely and safely. Advice was given regarding temperature control within the medication room. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users have their views respected, acknowledged and acted upon if necessary. Procedures and practices are in place to protect service users from abuse. EVIDENCE: The home was found to have an appropriate complaints policy and procedure. Responses in comment cards received from relatives and friends indicated they were aware of the complaints procedure. Two complaints had been received and investigated since the last inspection. These were minor in nature and had been investigated appropriately. The home has it’s own policy and procedure on protecting vulnerable adults from abuse. No POVA referrals had been made by or about the home since the previous inspection. Staff have received training on POVA issues. The home did not have available a copy of the London Borough of Enfield’s policy and procedure regarding POVA. It was advised that a copy be obtained. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users generally live in a homely, safe and comfortable environment which is clean and hygienic. EVIDENCE: The home was found to be quite homely during the inspection. Rooms were well decorated and there were many homely touches such as photographs of service users, pictures and ornaments. Service users bedrooms were of a good standard and they were personalised in a similar fashion to communal areas. The acting manager advised that new flooring is to be laid in various parts of the home and new furniture bought for some service users whose furniture is ageing. One service users bedroom carpet was seen to be in need of replacement and this was pointed out during the inspection. The home was found to be relatively clean and tidy during the inspection. There was no offensive odours present. No obvious safety hazards were seen during the visit. A requirement made at the previous inspection to have hand H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 17 drying facilities in all toilet areas had been addressed at the time of this inspection. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users are supported by competent staff in appropriate numbers. Staff are generally appropriately trained though more need to achieve nvq qualifications. The recruitment of staff is carried out in a professional manner. EVIDENCE: At the time of inspection, the acting manager advised the home was employing a total of seventeen care staff. Six staff had gained National vocational qualifications and four were in the process of achieving this qualification. When that happens the home will be in excess of fifty percent of nvq-qualified staff. Staff observed and spoken with presented as competent and knowledgeable about service users and their needs. Staff morale was good with one staff member describing the home as “one big happy family” Staff, as well as pursuing nationally recognised qualifications, have in the past months pursued individual training courses such as manual handling, food hygiene, first aid, epilepsy and the protection of vulnerable adults. Each staff member has an individual training record and there was an “at a glance” H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 19 record showing details of all training undertaken by staff. A member of staff spoken with confirmed she had undergone a three-day induction period at the home and that supervision was a regular feature of staff management arrangements in the home. Three staff files were sampled during the inspection and showed that staff recruitment practices are satisfactory. All files seen contained application forms and two references. Criminal records bureau checks had been undertaken and photo identity for staff was available. Staff spoken with confirmed they had undergone interviews. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. The acting manager is to apply for registration. Her motivation and commitment to the home were very apparent. The home takes regular account of the views of service users, staff and others as a means of developing and providing a quality service. The health, safety and welfare of service users is promoted and protected. EVIDENCE: The home currently has an acting manager. She has been in post for several months and is in the process of finalising her application for registration as manager of the home. She is also undertaking the registered managers award qualification. The acting manager was clearly enthusiastic and energetic in running the home with ideas on how to continually improve the service. For example, implementing new risk assessment forms and overseeing person H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 21 centred planning implementation for service users. Staff spoke well of her abilities and approachable style. The home undergoes regular quality auditing which takes in the views of service users, staff, families and significant others. The latest audit saw the home score highly in all areas and from all stakeholders. Up to date safety certificates were seen for fire equipment, electrical safety, gas safety, clinical waste and water safety. Servicing of hoist and bathing equipment had taken place on a regular basis. No safety hazards were seen during the visit. Regular tests of the fire alarm and fire fighting equipment were recorded. COSSH assessments as well as general risk assessments were seen and regularly reviewed. Staff had received training in health and safety issues such as first aid, infection control and manual handling. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 22 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 3 3 X 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 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 2 X 3 X X 3 X H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 23 No 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 YA24 Regulation 16 (2) (c) Requirement The registered provider must ensure suitable carpeting or flooring is available in areas of the home. The registered provider must ensure that fifty percent of care staff have national vocational qualifications in care at level two or above The registered provider must ensure that an application for registration of the acting manager is made to the CSCI Timescale for action 30/04/07 2. YA32 18 (1) (a) 31/07/07 3. YA37 9 28/02/07 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. Refer to Standard YA23 Good Practice Recommendations It is recommended that the home obtain a copy of the London Borough of Enfield’s policy and procedures in respect of the protection of vulnerable adults. H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 H.C.S. (Enfield) Ltd (Holtwhites Hill) DS0000010576.V321009.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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