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Inspection on 19/04/07 for H.C.S. (Enfield) Ltd (Southbury Road)

Also see our care home review for H.C.S. (Enfield) Ltd (Southbury Road) for more information

This inspection was carried out on 19th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 20 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a reasonable standard of care and support to a group of people with a range of complex needs. Two of the people who live in the home were able to tell the inspector how much they enjoy living in the home and how much they value their friendships with each other and their positive relationships with the staff. The home is supporting the residents to access healthcare professionals as required. The staff demonstrated a good knowledge of the people who live in the home and were able to recognise their individual needs and how to respond appropriately to them. The residents are supported to have their individual needs met by a comprehensive care planning system, which incorporates ongoing review meetings. Person Centred Planning is being developed in the home. The people who live in the home all feel able to express their views on the running of the home and their daily lives.The home is very clean, comfortable and homely and the service users each have an attractive single bedroom.

What has improved since the last inspection?

What the care home could do better:

Twenty requirements and two recommendations have been made at this inspection. Two requirements were made under the section choice of home and this was to provide an updated statement of purpose and to ensure staff receive training on diabetes and mental health so they can meet the specific needs of the people living in the home. Three requirements were made under the heading individual needs and choices. This was to ensure each person has a record of how they are supported to manage their personal finances, to ensure each person has a careplan that reflects their current needs and to ensure risk assessments reflect each persons healthcare needs. A recommendation was also made to ensure staff are familiar with the care plans and the care planning process. Two requirements were made under the heading of lifestyle to support service users to access a wider range of leisure activities in line with their personal interests on a regular basis, and to keep a record of what people eat for an evening meal. Three requirements were made under the heading of personal and healthcare to support people to have a high standard of personal care through haircuts and not wearing worn clothing, to enable the people living in the home to have their weight checked on a regular basis and to ensure the medication procedures are followed including the correct completion of the MAR sheet and the return to the pharmacist of medication that is no longer needed. A recommendation was also made to record medication received in the home on the MAR sheet to avoid duplication of records. A requirement was made in the section concerns, complaints and protection to ensure all the staff have received training on the protection of vulnerable adults. The section on the environment included three requirements including ensuring all the televisions in bedrooms are safely displayed, replacing old flooring in the bathrooms and toilets, replacing institutionalized armchairs, tidying the garden and providing a working fax machine in the house. In the section on staffing four requirements were made to employ a deputy manager, to ensure all the staff have ID in their records and to ensure all staff have a copy of their induction training and an up to date record of the training they have received and when this took place. Two requirements were made in the section called conduct and management of the home to ensure the appointed manager completes the registration process and to complete the work identified by the fire authority, ensure fire doors are not wedged open and to ensure staff have all been trained in fire safety.

CARE HOME ADULTS 18-65 H.C.S. (Enfield) Ltd (Southbury Road) 20-24 Southbury Road Enfield Middlesex EN1 1SA Lead Inspector Jane Ray Key Unannounced Inspection 19th April 2007 09:30 H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.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 (Southbury Road) DS0000010582.V333008.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 (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service H.C.S. (Enfield) Ltd (Southbury Road) Address 20-24 Southbury Road Enfield Middlesex EN1 1SA 020 8364 6923 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 ** Post Vacant *** Care Home 12 Category(ies) of Learning disability (11), Learning disability over registration, with number 65 years of age (1) of places H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Five specific service users who are currently resident in the home and are over 65 years of age may remain accommodated in the home. This condition must be reviewed at such times as any of the specified service users vacate the home. 25th April 2006 Date of last inspection Brief Description of the Service: Southbury Road is a care home managed by HCS (Enfield) Ltd and the registered provider is Mr Crausaz. The service is registered to provide 12 places to younger adults with a learning disability. The home was originally established to provide support to older people with a learning disability but over the years the service has been extended to younger adults with a learning disability and high physical care needs. The home currently has 5 service users who are over the age of 65. The home consists of a group of terraced houses, which were combined into one dwelling. Each service users has a large single bedroom. The home has a lift to the first floor. The people with higher physical care needs have bedrooms on the ground floor. There is one assisted bathroom on the ground floor. There are two dining areas. Service users can either eat at a table in the large kitchen area or alternatively in a small separate dining area, where a few of the more independent service users choose to eat. There are two lounges on the ground floor. Most of the residents also have a TV and a music system in their own rooms. There is a conservatory at the rear of the house, which acts as a sitting area and as a smoking area. There is a very pleasant garden with some sensory features. Staffing consists of a manager and team of care staff working on a morning and afternoon shift. The night shift is covered by two waking night staff. The home also has a domestic and cook who work on weekdays. The weekly fees of the home range between £883.00 and £1380.00. The level of the fees depends on the support and services provided. The provider must make information available about the service, including inspection reports to service users and other stakeholders. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 19 April 2007 and was unannounced. The inspection took seven hours to complete. The inspector was able to spend time with seven of the service users. The inspector was also able to speak to the five care staff who were on duty. The manager assisted the inspector. The inspector did a full tour of the premises and also looked at all the relevant records including service user records, staff files and health and safety information. The inspector also took advice from the local fire officer from the LFEPA and he provided additional feedback on the day after the inspection. The inspection is the annual key inspection and the aim is to look at how well the service is meeting the key National Minimum Standards for Younger Adults. The inspector also assessed the progress made by the service in meeting the requirements from the previous inspection. The inspector would like to thank the service users and staff for their assistance with the inspection process. What the service does well: The home provides a reasonable standard of care and support to a group of people with a range of complex needs. Two of the people who live in the home were able to tell the inspector how much they enjoy living in the home and how much they value their friendships with each other and their positive relationships with the staff. The home is supporting the residents to access healthcare professionals as required. The staff demonstrated a good knowledge of the people who live in the home and were able to recognise their individual needs and how to respond appropriately to them. The residents are supported to have their individual needs met by a comprehensive care planning system, which incorporates ongoing review meetings. Person Centred Planning is being developed in the home. The people who live in the home all feel able to express their views on the running of the home and their daily lives. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 6 The home is very clean, comfortable and homely and the service users each have an attractive single bedroom. What has improved since the last inspection? What they could do better: Twenty requirements and two recommendations have been made at this inspection. Two requirements were made under the section choice of home and this was to provide an updated statement of purpose and to ensure staff receive training on diabetes and mental health so they can meet the specific needs of the people living in the home. Three requirements were made under the heading individual needs and choices. This was to ensure each person has a record of how they are supported to manage their personal finances, to ensure each person has a care H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 7 plan that reflects their current needs and to ensure risk assessments reflect each persons healthcare needs. A recommendation was also made to ensure staff are familiar with the care plans and the care planning process. Two requirements were made under the heading of lifestyle to support service users to access a wider range of leisure activities in line with their personal interests on a regular basis, and to keep a record of what people eat for an evening meal. Three requirements were made under the heading of personal and healthcare to support people to have a high standard of personal care through haircuts and not wearing worn clothing, to enable the people living in the home to have their weight checked on a regular basis and to ensure the medication procedures are followed including the correct completion of the MAR sheet and the return to the pharmacist of medication that is no longer needed. A recommendation was also made to record medication received in the home on the MAR sheet to avoid duplication of records. A requirement was made in the section concerns, complaints and protection to ensure all the staff have received training on the protection of vulnerable adults. The section on the environment included three requirements including ensuring all the televisions in bedrooms are safely displayed, replacing old flooring in the bathrooms and toilets, replacing institutionalized armchairs, tidying the garden and providing a working fax machine in the house. In the section on staffing four requirements were made to employ a deputy manager, to ensure all the staff have ID in their records and to ensure all staff have a copy of their induction training and an up to date record of the training they have received and when this took place. Two requirements were made in the section called conduct and management of the home to ensure the appointed manager completes the registration process and to complete the work identified by the fire authority, ensure fire doors are not wedged open and to ensure staff have all been trained in fire safety. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 8 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 (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 9 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): Standards 1,2,3 and 4 were inspected. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who live in this service can be assured their needs will be assessed as part of their admission process. Whilst the staff have experience of supporting people with a learning disability they would benefit from additional training to meet the specific needs of the people living in the home such as training on diabetes and mental illness. EVIDENCE: I looked at the brochure prepared for the home but the manager was unable to find the statement of purpose. The brochure was a helpful document but did not cover all the necessary areas required for a statement of purpose. I looked at the case notes for four people who live in the home including the person who moved most recently to the service. The person who moved in most recently had a comprehensive assessment prepared by social services and an assessment prepared by the staff in the home. The other people whose records were checked also had comprehensive assessments. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 10 I discussed the current needs of the people who live in the home with the manager and inspected the staff training records. This indicated that the residents have a number of very specific individual needs including one person who has diabetes and another person who has mental health issues. The staff training records show no evidence that the staff have received training on either of these issues. One service user has epilepsy and most of the staff have received epilepsy training. I asked the staff about the process of supporting people to move into the home and I looked at the admission process in the brochure. Both these confirmed that people are able to visit the home as part of the process of deciding whether they want to move in and that their relatives are also welcome to visit. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 11 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): Standards 6,7,8 and 9 were inspected. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people living in the home can be confident that they will be supported to have an individual care plan and risk assessments. These documents would benefit from being amended as the needs of the residents change and the staff need further insight into the application of these individual plans. EVIDENCE: I inspected care plans for four people currently living in the home. I also spoke to the staff about the care plans. All four of the people whose records were inspected had comprehensive care plans in place. These were clearly laid out and covered all aspects of each persons needs in a user-friendly language. From my discussions with the manager and the staff I felt that the care plans H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 12 would benefit from being amended in a few areas. For example the staff felt one resident was becoming more confused and this was not reflected in her care plan. Another resident has a long-term mental illness and her care plan does not provide information on how she can be most effectively supported. The care plans had all been reviewed in the last six months. The people living in the home had all been supported to have a review meeting with their care manager and relatives in the last year. The minutes of these reviews were available and the action from these meetings had been addressed and the completion dates recorded. I asked two of the staff about the care plan goals for the people they support as key-workers and they were very vague. One member of staff said they “didn’t really have any goals” for the person she supported. I felt that the staff needed further support to understand the care planning process. The manager explained that a trainer is coming to the home to give guidance to the staff team on person centred planning and this is very positive. I spoke to three of the people living in the home about their key workers and they knew who they were and said they had a good relationship with them. The staff were asked about their key working role and were able to describe the support they gave and also said they attended the review meetings. I read the risk assessments for the same four people who live in the home. It was possible to see that an effort had been made to identify areas of personal risk and look at how this can be managed without place unnecessary restrictions on people. Where restrictions are needed, for example the staff hold one persons cigarettes on her behalf, the reasons for this are clearly recorded. I felt that the risk assessments needed to be reviewed to ensure that each persons healthcare needs were addressed. For example one of the people whose risk assessments were read had diabetes and no risk assessment is in place for this. The arrangements to support the people living in the home to manage their own finances were recorded in three of the four care plans that were viewed. The manager told the inspector that none of the residents has an advocate but one has a befriender who visits on a fortnightly basis. The manager explained that she has not arranged any resident meetings since she started working at the home at the beginning of the year. She has however booked a meeting for May and feels she has now got to know the residents and hopes they will feel able to express their views on the service they receive. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 13 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): Standards 11,12,13,14,15,16 and 17 were inspected. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living in the home will be able to follow a routine based on their individual choices and have meals linked to their preferences. Whilst some leisure opportunities are available there is still scope for this to improve. EVIDENCE: I spoke to the people living in the home and the staff about the activities. The manager explained that out of the ten people currently living in the home, three go to a day service four or five days a week. One person goes to a day service one day a week and one person is funded to have one hour of 1:1 staffing a day. The residents were able to tell me that they were occasionally going out and said this included going shopping, eating in restaurants and H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 14 visiting the cinema. The staff also explained that they now have access to a minibus and driver one day at the weekend and this means more people can go out. The staff acknowledged that whilst this represents progress since the previous inspection there is still scope for the number of community based activities to increase especially during the summer. In terms of holidays the manager and staff explained that four of the residents went to Blackpool last year. This year two of the residents are planning to go to Eurodisney and the others are hoping to have a number of day trips and these, need to be organised. The manager explained that the current people living in the home have chosen not to practice their religion. I also spoke to three of the people living in the home about this and they said they did not want to go to church at the moment. The manager explained that six of the people living in the home have regular contact with their relatives and either go to see them or the relatives visit the home. Some of the residents spoken to during the inspection told me how their relatives come to visit them. I was able to observe during the inspection that the people living in the home were able to follow a routine of their choice. Some of the more elderly residents had chosen to get up later and were able to have a leisurely bath and breakfast. The staff were observed sitting with the residents and chatting to them throughout the day. One person chose to sit and watch television in her own room. I saw the four-week menu and spoke to the cook who works on weekdays to prepare the lunch. The lunch was healthy and nutritious and there was adequate fresh food available. A record was kept of the food provided at lunchtime but there was only one week when a record was available of the suppers and this recorded that everyone had sandwiches. The cook said that she prepared an evening meal for the people who are at day centres and this is cooked by the care staff in the evening. I suggested that a record is kept of the evening meal to ensure that people who have not had a cooked lunch are offered a nutritious evening meal. I could see that food safety standards were being maintained and fridge / freezer temperatures were being monitored. I saw that the cook has a current food hygiene-training certificate. The cook explained that the person living in the home who has diabetes follows a healthy diet and eat the same main meal but has fruit or a yogurt for desert and another person has their food pureed and thickened to ensure she swallows it safely. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 15 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): Standards 18,19 and 20 were inspected. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The people living in the home are supported to access ongoing healthcare support from a range of professionals. There are however areas that need to be improved to ensure personal care is of a high standard and medication is administered safely at all times. EVIDENCE: I observed during the inspection that the staff were supporting the people living in the home to receive personal care in a manner that preserved their privacy and dignity. It was however noted that two of the people had rather unkempt hair and one person was wearing a torn dressing gown. The manager explained that she is arranging for the residents to go out to a local hairdressers rather than use the current hairdresser who visits the home. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 16 I looked at the healthcare records for four of the people living in the home. They had all been supported to access a range of healthcare professionals including the GP, dentist, optician and other outpatient appointments according to their individual needs. One resident was having ongoing neurology input to monitor his epilepsy and another was having her mental health monitored by the psychiatrist. I observed however that none of the people had a record of having their weight monitored and the manager confirmed that the residents were not being supported to check their weight at present. I looked at the medication, administration records and staff training records. The home uses the Lloyds pharmacy medication administration system. The medication is stored in a locked cupboard in the office and the temperature of the cupboard is checked daily. The manager said that none of the residents are self- administering their medication. One resident has PRN rectal diazepam and there are clear guidelines in place for when and how this should be administered. The home has separate sheets to record medication received in the home and a daily total of how much medication is available. I recommended that the staff use the appropriate box on the medication administration sheet to record the medication received to avoid duplicating the work. The administration records showed a few errors such a gap for one service user on one day, no record for one person of whether their cream is being used and no record of what medication was being administered for one resident who had received a course of antibiotics. In the medication cupboard I observed that a couple of items of medication needed to be returned to the pharmacist as they were no longer in use. The home does not currently carry out its own internal medication audit. The training records show that 12 staff received medication training in 2005 and further training is booked in July 2007. The manager confirmed that only staff who have been trained administer the medication. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 17 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): Standards 22 and 23 were inspected. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People living in the home are protected by the appropriate use of adult protection procedures, complaints procedures and systems for supporting residents to manage their finances. About two thirds of the team need to receive training on the protection of vulnerable adults although a training date is booked. EVIDENCE: I looked at the record of complaints and whilst there have been no complaints since the last inspection an appropriate format is available to record complaints. I spoke to two staff about what they would do if they received a complaint and they were both able to respond appropriately. I observed that the home has a copy of the appropriate local authority adult protection procedure. Since the last inspection there has been one adult protection strategy meeting following concerns raised by social services about a service user who had fallen and had bruises on her face. The staff from the home appropriately participated in this process. I looked at the staff training records and only one third of the staff team had received POVA training but further training is booked in August 2007. I spoke to two staff on duty who demonstrated a good knowledge of what constitutes abuse and what action they would need to take if they were concerned that abuse was taking place. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 18 I checked the personal finances for two residents including their building society books, cash record, cash and receipts. These were all accurate and provided evidence that appropriate systems were in place to protect the residents from financial abuse. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 19 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): Standards 24,25,27,28 and 30 were inspected. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People living in the home can know that they are living in an environment that is clean and comfortable. A few further areas of improvement are however needed to ensure the home is pleasant and safe. EVIDENCE: I did a tour of the home with a member of staff. The building consists of three terraced houses that have been joined together. The building is located on a main road within easy reach of Enfield Town and local shops. The building is on two levels and a lift is available. The layout of the building means that there is a long corridor particularly on the upper floor. Each person living in the home has an individual bedroom. A number of these rooms have been refurnished and decorated in the last year and are very H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 20 pleasant. There is a plan to decorate the remaining bedrooms where this is needed. The bedrooms are comfortable and individually personalized. It was however noticed in a few of the bedrooms that televisions are perched on bedside tables or chest of drawers and are not very secure. Toilets and bathrooms are found throughout the house, but the disabled accessible bathroom on the ground floor is the bath used by most of the people living in the house. It was observed that some of the bathrooms and toilets have red flooring that is old and marked and this needs to be replaced. The home has a large kitchen / dining area. There is a large and a small lounge. Three of the people who live in the home, also eat in the small lounge. A small conservatory area at the rear of the house is the smoking area. It was observed that some of the lounge chairs are very institutionalized and need to be replaced with chairs that are more comfortable and appropriate. I observed that the home was clean throughout and there were no unpleasant odours. The utility room had a washing machine and tumble drier and these were both working. The garden is very pleasant and needs to be cleared and tidied so it is ready for the residents to enjoy. The office is located on the first floor and I saw there was no working fax machine and the home does not yet have access to the internet. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 21 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): Standards 32,33,34,35 and 36 were inspected. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people living in the home are supported by a stable team of staff who are offered an ongoing programme of training. The manager does however need to be supported by another senior member of staff and the staff need to receive regular supervision. EVIDENCE: The pre-inspection questionnaire showed that there are 20 staff working at Southbury Road of which there is one manager, 17 care staff, 1 cook and 1 cleaner. The staff turnover is low and the manager explained that at the time of the inspection there was only one staff vacancy. The manager said she would like to appoint a deputy manager to help oversee the service and I felt this was very necessary in a home of this size. The staffing levels are four care staff on the day shifts and two waking night staff. The manager explained that H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 22 monthly staff meetings take place and I looked at the records and these show that a range of operational issues are discussed. The manager explained that three staff have completed an NVQ in care at level 2 or 3. An additional twelve staff are currently studying for the qualification. I looked at the recruitment records for three staff recruited in the last 12 months and three staff who have worked in the home for a longer period. It was found that all the staff had two references and a CRB disclosure. One member of staff did not have ID available. All the staff had a contract of employment. I inspected the training records. I looked at the induction records for the three staff employed in the last year and one member of staff had no induction record available. The home has a training matrix but this was not up to date and so it was not possible to accurately tell who had received training and when this had taken place. An ongoing training programme is in place including all the mandatory training. I looked at the supervision records for the six staff. They had all received individual supervision but this had not taken place on a regular basis and some had gaps of four months between their supervision sessions. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 23 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): Standards 37,39 and 42 were inspected. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The people living in the home can know that the service is well managed although the manager needs to complete the registration process. They are also able to give their views on how the home is run through the quality assurance exercise. Their safety is however compromised by some urgent fire safety work that needs to take place. EVIDENCE: I was able to spend part of the inspection with the manager and could see she has considerable skills and experience which means she is managing the home H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 24 very effectively. The manager explained that she has started the process of applying for registration. I was able to look at the outcomes of the quality assurance exercise that was undertaken six months ago. This seeks the views of the people who live in the home, relatives, staff and care professionals. Where this had identified areas for improvement an action plan had been prepared. I looked in detail at health and safety and was concerned about fire safety in the home. I observed as I walked around the home that a number of fire doors were wedged open and that dorguards were not correctly fitted and in one case was being held open by cardboard. I was also concerned as there are five people with bedrooms upstairs who in the event of a fire would not be able to come down the stairs. I contacted the LFEPA for advice and they were able to send a fire officer the following day to the home and they have required a number of areas of work on fire doors and to amend the evacuation plans. Other areas of fire safety were satisfactory including the fire alarm and extinguishers being serviced, a fire safety risk assessment in place and monthly fire drills taking place. I looked at the staff training records and these showed that only two of the staff had current fire safety training and no training date is planned. I checked that the other equipment in the home had been serviced and this had taken place and certificates were in place for the portable electrical appliances, electrical installations, gas, hoist and lift. I inspected that staff health and safety training records. Most of the staff had received training in moving and handling, first aid, food hygiene and infection control. Additional training dates are also available in the next three months for staff who have not had the training. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.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 2 2 3 3 2 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 2 26 x 27 2 28 2 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 x LIFESTYLES Standard No Score 11 3 12 3 13 2 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 x 2 x 3 x x 1 x H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? None 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 YA1 Regulation 4(1) Requirement The registered person must ensure an updated statement of purpose is available in the home and a copy sent to the CSCI so it is clear what the service is able to provide. The registered person must provide training for the staff so they can meet the specialized needs of the people in the home including training on diabetes and mental health. The registered person must ensure the care plans reflect the changing needs of the people living in the home. The registered person must ensure each resident has a record of how they are supported to manage their finances to ensure these arrangements are in place. The registered person must ensure each persons risk assessments are comprehensive and reflect their healthcare needs. The registered person must support the service users to have regular access to ongoing DS0000010582.V333008.R01.S.doc Timescale for action 30/06/07 2. YA3 12(1) 31/07/07 3. YA6 15(2)(b) 30/06/07 4. YA7 12(1) 31/05/07 5. YA9 13(4) 31/05/07 6. YA13 16(2)(n) 31/05/07 H.C.S. (Enfield) Ltd (Southbury Road) Version 5.2 Page 27 7. YA17 16(2)(i) 8. YA18 12(1) 9. YA19 12(1) 10. YA20 13(2) 11. YA23 13(6) 12. YA25 13(4) 13. 14. YA27 YA28 23(2)(b) 23(2)(b) 15. 16. YA33 YA34 18(1) 19(1)-(5) community based leisure activities. The registered person must keep a record of food consumed in the evening to ensure the residents are eating a healthy and nutritious diet. The registered person must ensure the people living in the home are supported to receive a high standard of personal care including proper haircuts and wearing clothing that is in good condition. The registered person must ensure the people in the home are supported to check their weight on a regular basis. The registered person must ensure the medication systems are being implemented fully including the correct completion of the MAR sheets and returning medication that is no longer in use to the pharmacist. This must be supported by a regular medication audit. The registered person must ensure all the staff have received training in the protection of vulnerable adults. The registered person must ensure that the televisions in service users bedrooms are safely installed. The registered person must replace the red flooring in the bathrooms and toilets. The registered person must replace the institutionalized armchairs, tidy the garden and ensure a working fax is available in the home. The registered person must ensure a deputy manager is in place to support the manager. The registered person must ensure all staff have a copy of DS0000010582.V333008.R01.S.doc 15/05/07 15/05/07 30/06/07 15/05/07 31/07/07 31/05/07 30/08/07 31/07/07 31/07/07 31/05/07 Page 28 H.C.S. (Enfield) Ltd (Southbury Road) Version 5.2 their ID in their staff records. 17. YA35 18(1)(c) The registered person must ensure all the staff have a completed induction and that there is an updated record of what training each member of staff has received and when this training took place. The registered person must ensure each member of staff receives regular supervision to ensure their work is an appropriate standard. The registered person must ensure the manager completes the registration process. The registered person must ensure the home completes the work specified by the fire authority, must not wedge open fire doors and must ensure all the staff have undertaken fire training. 31/05/07 18. YA36 18(2) 31/05/07 19. 20. YA37 YA42 9(1) 23(4) 30/06/07 30/06/07 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. 2. Refer to Standard YA6 YA20 Good Practice Recommendations The registered person should ensure that staff have an upto-date know service users’ care plans and risk assessments. The registered person should record medication received onto the MAR sheet to avoid duplication of records. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V333008.R01.S.doc Version 5.2 Page 29 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. 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