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Inspection on 05/06/08 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 5th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 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

What has improved since the last inspection?

The last key inspection took place on the 22 October 2007. This showed that progress had been made in working towards a number of the requirements, although in some areas further input was needed. The residents and staff all said that there have been more community based activities and this has included trying some new activities such as trampolining at a local sports centre. The record of food eaten is being kept to ensure everyone is eating a healthy diet. The medication that is being delivered to the home is being recorded on the medication administration record to keep an accurate check of the quantity of medication available. The resident`s views on the running of the home and their personal wishes are being developed through the key-working system. Staff are also communicating effectively with the residents by making good eye contact and interacting during personal care. Staff have copies of their ID in their staff records apart from one member of staff who has unusual personal circumstances and has provided alternative ID whilst the matter is being resolved. All the staff have been booked for fire training, although this training has not yet taken place.

What the care home could do better:

This report has made a number of requirements and recommendations. The support given to some of the residents could be improved by ensuring all the staff have training in dementia. Some residents need to have a contract so there is clarity about what the home will provide for the resident as part of their fee. The care plans need to be more user friendly and up to date, to inform the care that is provided. Key worker sessions with the residents should also be recorded so that the progress with any agreed action can be monitored. Providing ways of enabling people to continue to develop their independence should continue to be explored. Residents should be supported to check their weight regularly as this is a useful measure of any changes that could relate to the persons health. Risk assessments must be put into place for residents who have a pressure sore or are at risk of developing one to ensure all the necessary action by staff is taking place to prevent the skin breaking down or helping the skin to heal. A record of staff signatures must be availablewith the medication records so that if there are any queries the correct member of staff can be contacted. In terms of safeguarding the residents, all potential safeguarding issues must be discussed with social services to agree the appropriate action. Receipts must be available for resident`s expenditure of personal monies, where the staff support them to manage their monies. Residents should also be supported to ensure they are receiving the correct DSS benefits. The environment of the home needs to continue to improve through an ongoing maintenance and decoration programme. The current manager needs to complete the registration process. She should be encouraged to keep the records in the home well organised. The views of people involved in the home should be sought and a quality assurance exercise completed. To improve health and safety in the home a fire emergency plan must be completed and the portable electrical appliances and the hoist must have certificates available to confirm they have been maintained.

CARE HOME ADULTS 18-65 H.C.S. (Enfield) Ltd (Southbury Road) 20-24 Southbury Road Enfield Middlesex EN1 1SA Lead Inspector Jane Ray Unannounced Inspection 5th June 2008 10:00 H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.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.V364948.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.V364948.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) southburyroad2024@btconnect.com H.C.S.(Enfield) Ltd Manager 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.V364948.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd October 2007 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 6 residents who are over the age of 65. The home consists of a group of terraced houses, which were combined into one dwelling. Each resident 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. People 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 residents 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, deputy 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. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report). H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.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 1 star. This means the people who use this service experience adequate quality outcomes. The inspection took place on the 5 June 2008 and was unannounced. The inspection lasted for six hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given six of the ten current residents. The inspector was also able to speak individually to a few of the residents. Unfortunately the acting manager was not available during the inspection and the Area Manager came to the home for part of the inspection to assist, which was very much appreciated. The inspector interviewed two of the care staff and spoke briefly to other members of the team. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self-assessment questionnaire (AQAA) prior to the inspection. In addition the inspector received eight completed surveys from two relatives, two residents and four staff. 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, particularly older people with a learning disability who may have dementia. The people who live in the home were able to tell the inspector how much they enjoy living in the home or were observed to look happy and relaxed in their home environment. One person said, “we are very happy here”. A relative in a survey response said, “I am very impressed with the care and attention that’s been given to my relative”. The home is supporting the residents to access healthcare professionals as required to meet their primary and more complex needs. The staff team are very stable and many have worked at the home for a number of years and demonstrate 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. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 6 The key-working system works effectively and residents know who their key – worker is and it provides an appropriate system for ensuring each resident gets their individual needs met. The people who live in the home all feel able to express their views on the running of the home and are supported to make choices in their daily lives. The home whilst rather old is clean, comfortable and homely and the residents each have an attractive single bedroom. The home is also well located to provide easy access to the local supermarket and the town centre. What has improved since the last inspection? What they could do better: This report has made a number of requirements and recommendations. The support given to some of the residents could be improved by ensuring all the staff have training in dementia. Some residents need to have a contract so there is clarity about what the home will provide for the resident as part of their fee. The care plans need to be more user friendly and up to date, to inform the care that is provided. Key worker sessions with the residents should also be recorded so that the progress with any agreed action can be monitored. Providing ways of enabling people to continue to develop their independence should continue to be explored. Residents should be supported to check their weight regularly as this is a useful measure of any changes that could relate to the persons health. Risk assessments must be put into place for residents who have a pressure sore or are at risk of developing one to ensure all the necessary action by staff is taking place to prevent the skin breaking down or helping the skin to heal. A record of staff signatures must be available H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 7 with the medication records so that if there are any queries the correct member of staff can be contacted. In terms of safeguarding the residents, all potential safeguarding issues must be discussed with social services to agree the appropriate action. Receipts must be available for resident’s expenditure of personal monies, where the staff support them to manage their monies. Residents should also be supported to ensure they are receiving the correct DSS benefits. The environment of the home needs to continue to improve through an ongoing maintenance and decoration programme. The current manager needs to complete the registration process. She should be encouraged to keep the records in the home well organised. The views of people involved in the home should be sought and a quality assurance exercise completed. To improve health and safety in the home a fire emergency plan must be completed and the portable electrical appliances and the hoist must have certificates available to confirm they have been maintained. 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.V364948.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.V364948.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 1,2,3,4 and 5 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that their individual needs will be assessed and that the staff have the skills and ability to meet these needs. New people moving to the service will be supported to settle into the service. The absence of contracts for some residents means there is not clarity about what the home will provide to each person. EVIDENCE: We looked at the statement of purpose at the previous inspection and this was found to be comprehensive and provided all the necessary information in a clear manner that would be understood by relatives and care professionals. We looked at the case notes for four people who live in the home including the person who moved most recently to the service. The residents all had comprehensive assessments prepared by the home. These assessments form the basis for the care plans. The person who had moved into the home since H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 10 the previous inspection had background information provided by her previous placement. We discussed the current needs of the people who live in the home with the care staff 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. In addition one resident has dementia and several other residents are becoming more confused. At the previous inspection it had been recorded that a local community nurse has provided training sessions on dementia, diabetes and mental health. The current staff training records show that out of the twenty staff four staff still need training on dementia. The company programme of ongoing training does not include this topic. The training records for four individual staff were also inspected. One of the four staff needed her epilepsy training updated by the learning disability team, but this training is no longer such a priority as the resident who needed assistance in this area is no longer living in the home. One resident has moved into the home since the last inspection. The staff explained that her relatives and care manager visited the service before her move, but a visit was not felt to be helpful for her as she was coming from a long distance away. The staff said that they spent a lot of time with her after her move to make her feel welcome and that she is settling well. The contracts between the home and the resident were inspected for four residents including the resident who moved most recently to the home. Two of the four residents did not have a contract in their individual records. Where the contracts were in place they were in a user-friendly format as part of a service user guide and indicated what the home would provide for the resident as part of their fee. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.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. People using this service experience adequate outcomes in this area. 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 make choices in their daily lives. Further work is needed on the person centred plans to ensure they reflect the wishes of the residents and are being appropriately monitored and reviewed. EVIDENCE: We inspected care plans for four people currently living in the home. We also spoke to the staff about the care plans. All four of the people whose records were inspected had a person centred care plans in place. These were clearly laid out and covered all aspects of each persons needs in a user-friendly language. The care plans were not however in a format that was accessible or meaningful for the residents themselves. One resident was asked if she had seen her care plan and she said she had not. These care plans had been H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 12 prepared in July 2007 and had not been updated even though it was apparent from talking to staff that peoples needs had changed during that time. The people living in the home had all been supported to have a review meeting with their key worker and relatives in the last year although not all had a record of meeting with their care manager during that time. The care plans did not have individual goals or evidence of a review process as noted at the previous inspection. On the day of the inspection the manager was attending person centred planning training arranged by Enfield Social Services. The Area Manager explained that she is planning to use this training to review all the care plans. We 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 especially with shopping and healthcare appointments. It was evident from discussions with residents that their relationship with their key-worker was very important. One resident said, “if I want anything I ask my key-worker”. We 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. The staff explained that one resident is being treated for a pressure sore and another resident has been identified as being at risk of developing a pressure sore. This needs to be reflected in these residents risk assessments and identify all the actions the staff need to take to help the residents recover or to reduce the risk. The arrangements to support the people living in the home to manage their own finances were recorded in all of the care plans that were viewed. This record was however unclear for the resident who moved most recently to the home as it does not record who acts as her appointee and how she is supported to manage her monies on a daily basis. The Area Manager explained that at the present time, no residents were being supported by an advocate although one person may be referred for this input. Each person living in the home had as part of their care plan guidelines on how to support them if they had complex or challenging behaviours. It was observed that one resident showed signs of distress and was shouting out very loudly at different times during the day. The staff were supporting her very appropriately asking her if she wanted anything and being very reassuring. Her care plan did not however provide any clear guidelines on how she should be supported. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 13 We observed the people living in the home and their interaction with the staff. It was positive to note that they were being facilitated to make choices including when they wished to get up or move around the home, when they were ready to eat and what they wanted to eat or drink. The staff were observed to be very aware of both verbal and non-verbal communication. They were also able to describe how they facilitate choices by for example holding up two items of clothing to enable the resident to indicate their preference. The staff explained that at the time of the inspection no resident meetings were taking place and their views were being sought through monthly keyworker sessions. In the four service user case notes that were inspected, only one person had a record of a key-worker session. In the AQAA prepared by the manager it was recorded that the plans for improvement include developing the house meetings for the residents. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 14 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. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to develop their daily living skills and are also enabled to follow their own routine. The home has made progress in supporting the residents to enjoy a good range of activities during the day and to enjoy accessing the local community. EVIDENCE: We spoke to the people living in the home and the staff about the activities. The AQAA also explained that out of the ten people currently living in the home, two go to a day service five days a week, one person goes to a day service two days a week and one person goes one day a week. One person is funded to have one hour of 1:1 staffing a day. The residents were able to tell me that they were going out as much as they wanted and said this included H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 15 going shopping, eating in restaurants and visiting the cinema or theatre. One resident said, “I go down the town and get what I want. I buy toiletries, clothes sometimes and we have a cup of coffee”. The staff also explained that they are organising for everyone to have a bus pass and encouraging them to use public transport. The staff also talked about new activities that are being introduced including the use of facilities at a local sports centre. The staff explained how they try to support the residents to do as much as possible for themselves. This includes their personal care as well as domestic activities in the home. One member of staff explained how one resident likes to help with dusting. She also said that another resident is encouraged to sort her laundry and put it away. At the last inspection it was identified that the staff always hold the residents monies for them when they go out and a resident and a member of staff said this arrangement had not changed. In terms of holidays the staff explained that two of the residents went to Eurodisney but one resident had to cancel her holiday in Tenerife due to healthcare issues. The staff explained that they are planning some day trips, as this is the choice of the residents. One member of staff said she hoped the weather stayed good as she was planning to take one of the residents to Paradise Park. One resident and the staff talked about how they enjoy celebrating birthdays in the home. One resident said that she went out for lunch and then had a party in the home in the afternoon. She said “everyone joined in with a party for my birthday”. We were able to observe during the inspection that the people living in the home were able to follow a routine of their choice. One resident said “I go to bed when I want, usually at 10 or 11pm, it depends what is on the telly”. The AQAA identified that the residents are mainly Christian and one person is Muslim. Most of the residents choose not to visit a place of worship and one person celebrates religious festivals with their family. The AQAA also explained that three of the people living in the home have regular visits from their relatives and two others keep in touch with relatives by letter. One relative in a survey response said, “the staff always make you feel welcome when visiting”. One person has a visitor from Mencap and another has a befriender who keeps in touch by letter. Two of the residents have a very close friendship with each other and choose to sit together. We saw the four-week menu and spoke to the staff members who were preparing the food. The menu has changed since the last inspection with a greater variety of evening meals. The lunch was healthy and nutritious and there was adequate fresh food available. The record of the food eaten was inspected. We were still concerned as on one day a resident who had been to H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 16 the day centre only had a sandwich in the evening. The staff explained that on that day she had taken money with her to the day centre, which meant she would have had a cooked lunch out. During the inspection food was bought from the supermarket and one resident went with the staff to help with the shopping. The Area Manager explained that the manager is planning to buy most of the food through the internet and then involve residents much more in buying fresh food. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 17 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. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs and they can be assured that their medication will be administered safely. EVIDENCE: We 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 also observed that the staff communicated with the residents in an appropriate manner, sitting down with them and making good eye contact. There was a friendly and warm relationship between the residents and the staff team. One resident said, “all the staff are really kind”. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 18 The residents were observed to be wearing nice clothes and to have had haircuts. The staff explained that a hairdresser visits the home each month. Some of them were able to talk about how they had been out shopping. We 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. It was also positive to see that two of the residents had been supported to receive input from the physiotherapist and occupational therapist in order to maximize their mobility and independence. Advice from the continence advisor has also been sought where needed. At the last inspection it was recommended that residents were weighed each month, especially if this is a matter of concern. The staff explained that the residents have been supported to attend a health clinic but this has not been happening regularly. The manager is now arranging for residents to be supported to check their weight in the home but so far the records show only four people have been weighed. We 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 home is now recording on the administration record the medication received when it is in the blister packs as well as the medication returned to the pharmacy and this ensures there is an audit trail for each medication available. The administration records were correctly completed. There was no out of date or no longer used medication in the cupboard. The training records show that medication training is up to date for eighteen of the twenty staff. There is no record of the staff signatures for the staff who administer the medication although a daily shift plan is completed allocating tasks to the team and this records who has given medication. The only medication that is given as required is pain relief and this is given at the request of the resident. No contolled drugs were used at the time of the inspection. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 19 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. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home have access to an appropriate complaints procedure and are protected by staff having received up to date training on safeguarding vulnerable adults. There could be some improvements in the system for managing resident’s monies to ensure they are properly accounted for. EVIDENCE: The AQAA stated that there had been one complaint in the last year. The organisation has a complaints procedure that is clear and easy to use. One resident when asked about how she would complain if she needed to do so said she would speak to the manager or her key-worker. The record of complaints was inspected and the one complaint appeared to be appropriately addressed. There have been no adult protection issues since the last inspection. We did however see in the complaints record a note that one of the residents had talked about being shouted at by a member of staff. There was a record that this had been addressed by speaking to the staff member concerned. There was no evidence that safeguarding procedures had been used and the allegation discussed with social services. Copies of the organisations procedures and social service procedures are available in the home but may not be being fully put into practice. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 20 We looked at the staff training records and these show that most of the staff had received safeguarding vulnerable adult training and for the three staff who need the training this is booked for mid June. We spoke to the care staff about the safeguarding adults procedure and they all displayed a good knowledge of the procedures and the importance to speaking to the manager about issues that arise. We checked the personal finances for four residents including their building society books, cash record, cash and receipts. Some of the residents have the local authority as their appointee and some residents are supported by a company appointee. All the residents have a building society account. The manager is responsible for supporting the residents to manage their personal monies and is the only person in the home with access to the building society books. In the home there is an individual finance record for each person and their cash is held in a lockable filing cabinet. All expenditure is recorded and receipts are usually available. It was however observed for one resident that recent receipts could not be located. It was also noted for another resident that the balance in her building society book was reducing and it was not possible to tell if she was in receipt of all her DSS benefits. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 21 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. People using this service experience adequate outcomes in this area. 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. Ongoing maintenance is required as parts of the home are in need of work. EVIDENCE: We did a tour of the home with the manager. 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. These are gradually being redecorated. The bedrooms are comfortable and individually H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 22 personalized. Since the last inspection some of the bedrooms have had new carpet. 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. The AQAA said that they are aiming to obtain advice from an occupational therapist to develop bathing facilities upstairs that are accessible for the residents. 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. Since the last inspection new dining chairs have been provided. We observed that the home was clean throughout, although there was a smell of urine in one room. The staff explained that this is due to one resident who has recently developed a continence issue that is being addressed with the doctor. The utility room had a washing machine and tumble drier and these were both working. The office is located on the first floor and now has internet access. It was observed that whilst some decoration has taken place parts of the house were starting to appear worn and in need of minor repairs or redecoration. This includes the external decoration. This particularly applies to areas like skirting boards. The Area Manager said they are planning to replace the conservatory but an ongoing maintenance and decoration programme needs to remain in place. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 23 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. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A stable team of staff provide consistent care to the people living in the home. The staff are receiving relevant ongoing training and are supported by regular team meetings. This enables them to work to a high standard and deliver good care. EVIDENCE: The rota showed that there are 20 staff working at Southbury Road of which there is one manager, 17 care staff, 1 cook and 1 cleaner / carer. The staff turnover is low and since the last inspection one carer has transferred from another service. The staffing levels are four care staff on the day shifts and two waking night staff. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 24 The AQAA completed by the home stated that thirteen staff have completed an NVQ in care at level 2 or 3. An additional four staff are currently studying for the qualification. We looked at the recruitment records for one staff member who moved to the service since the last inspection. All the recruitment checks were in place including a CRB disclosure. This member of staff did not however have a photo ID, although a record was available to say an out of date passport was being replaced. A clear timescale should be agreed for the staff member to provide photographic ID. Four other staff records were inspected and these all contained appropriate ID with permission to work in the country if needed. We inspected the training records. The home has a training matrix and this was up to date and so it was 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. We spoke to the staff who were able to describe their ongoing training and said they found this very useful. We looked at the supervision records for the four staff. They had all received individual supervision but at the time of the inspection this was due to be updated. The manager sent through a list of dates for supervisions the day after the inspection. Supervisions must take place regularly to ensure staff are supported to maintain a good standard of care. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 25 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 and 42 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a new manager but she needs to complete the registration process. There is not yet adequate management support available in the home as the deputy post is not filled. Progress has been made to improve fire safety in the home but an emergency plan needs to be completed. EVIDENCE: Since the last inspection a new manager has come into post. The staff felt she was making good progress. The residents also said they liked her. One member of staff said, “we are now much clearer about our roles and responsibilities and what we need to complete on each shift”. Another member H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 26 of staff said that she felt there was better communication. In a survey one member of staff wrote “I think the service is actually doing well in all aspects of giving the right support to both the residents and the staff”. Since the last inspection a deputy manager came into post and then resigned from this role and at the time of the inspection this post was vacant. We noticed that the records in the office were not particularly well maintained and wondered if this was partly as a result of the manager having too much to do. This manager must complete the registration process. The Regulation 26 visits to the home had taken place regularly and the reports were inspected. These said that the annual quality assurance questionnaires had been sent out although only three completed questionnaires from relatives were available. The last full quality assurance exercise took place in 2006 and so this exercise needs to be updated and completed. In terms of fire safety we looked at the fire safety risk assessment and this was now complete. The service did not have a full emergency plan in place. The fire alarm and fire extinguishers had been serviced. The fire alarm records show the alarm is checked weekly and the last fire drill had taken place three months ago and so the next drill is due to take place. Fire safety training has been booked for the whole staff team. The AQAA showed that some of the health and safety maintenance checks were out of date. The certificates were inspected and the portable electrical appliances and the hoist had no record of a maintenance check. After the inspection it was confirmed that these checks had taken place where needed. The staff training records show that the staff have either completed or are booked to attend most of the health and safety training including food hygiene, moving and handling, first aid and infection control. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 2 4 3 5 2 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 2 25 3 26 x 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 2 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 2 x x 2 x H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 YA3 Regulation 12(1) Requirement The registered person must ensure all the staff can meet the needs of the residents by arranging for them to have dementia training. The registered person must ensure that each resident has a completed contract so it is clear what the service will provide. The registered person must ensure the care plans include individual goals and are reviewed on an ongoing basis. This requirement is restated, previous timescale of 31/12/07 was unmet. The registered person must ensure all risks are appropriately addressed by keeping each persons risk assessment updated including pressure care. The registered person must ensure a record of staff signatures for staff who administer medication must be kept with the medication administration records. This requirement is restated, previous timescale of 30/11/07 was unmet. DS0000010582.V364948.R01.S.doc Timescale for action 30/09/08 2. YA5 5(1)(b) 31/07/08 3. YA6 15(1)(2) 30/09/08 4. YA9 13(4) 31/07/08 5. YA20 13(2) 31/07/08 H.C.S. (Enfield) Ltd (Southbury Road) Version 5.2 Page 29 6. YA23 13(6) 7. YA24 23(2)(b) 8. YA37 9(1) 9. YA39 24 10. YA42 23(4) 11. YA42 13(4) The registered person must ensure that all potential allegations of abuse are discussed with social services in line with safeguarding procedures to decide if further action is appropriate. The registered person must ensure an ongoing maintenance and decoration programme is implemented in the home. This requirement is restated, previous timescale of 31/01/08 was unmet. The registered person must ensure the manager completes the registration process. This is a new requirement as a new manager has come into post. The registered person must complete this years quality assurance exercise to seek the views of residents, relatives and other stakeholders on the standard of service provided by the home. The registered person must complete a fire safety emergency plan in line with the guidance from the fire services. The registered person must ensure the certificates to confirm the portable electrical appliances and the hoist have had a maintenance check are available. 31/07/08 30/09/08 31/08/08 30/09/08 31/08/08 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000010582.V364948.R01.S.doc Version 5.2 Page 30 H.C.S. (Enfield) Ltd (Southbury Road) 1. 2. Standard YA6 YA6 3. 4. YA7 YA16 5. 6. YA19 YA23 7. 8. 9. YA34 YA38 YA37 The registered person should support the residents to have a care plan in an accessible meaningful format. The registered person should ensure all the residents have had a review meeting with their care manager in the last year and obtain a record of that meeting if this is not already in the home. The registered person should ensure that monthly sessions with key-workers are recorded so they can be monitored. The registered person should continue to explore ways to support the residents to further develop their independence such as holding their own money when out shopping. This recommendation is restated. The registered person should support the residents to monitor their weight and keep a record in the home. The recommendation is amended and restated. The registered person should ensure the system of keeping receipts for resident’s monies enables recent receipts to be available. They should also ensure that all the residents are receiving the correct DSS benefits so they have adequate spending money. The registered person must ensure that the staff member who does not have photo ID, provides this document within agreed timescales. The registered person must ensure that the manager supervises all the staff every two months. The registered person must ensure the manager keeps all the records in the home in an organised manner. H.C.S. (Enfield) Ltd (Southbury Road) DS0000010582.V364948.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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