Inspection on 12/10/05 for Southlea Residential Care Home

This inspection was carried out on 12th October 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Southlea Residential Care Home 18/08/08

Southlea Residential Care Home 18/07/07

Southlea Residential Care Home 13/09/06

Southlea Residential Care Home 06/05/05

Southlea Residential Care Home 04/11/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Southlea Residential Care Home 23a Cross Lane Radcliffe Manchester M26 2QZ Lead Inspector Mike Murphy Unannounced Inspection 12 October 2005 09:30a Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 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 Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 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. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Southlea Residential Care Home Address 23a Cross Lane Radcliffe Manchester M26 2QZ 0161 764 0761 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) Southlea Limited Mrs Margaret Yvonne White Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3) Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the maximum registered numbers 5 , there can be up to 3 MD(E) Adults with Mental Disorder over 65 ; 2 MD Adults with Mental Disorder. The service should at all times employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection 6th May 2005 Date of last inspection Brief Description of the Service: Southlea is a privately owned care home registered to provide care and support for up to 5 people with mental health needs. The home is a large Victorian property situated on a main road in the Radcliffe area of Bury. It is close to several amenities and has good transport links. The metro-link is close by and Bury is a 5-minute bus/tram ride away. Accommodation is provided in single rooms with en-suite facilities. The home provides practical and emotional support 24 hours a day from staff with training in, and knowledge of, mental health needs. Staff work closely with other professionals to ensure that the needs of service users are met and reviewed. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the home’s second of two annual inspections for the inspection year 2005 to 2006. The inspection took place over three hours. The inspection included discussion with residents, a tour of the premises, inspection of care and other records maintained at the home and discussion with management. What the service does well: What has improved since the last inspection? What they could do better: The manager informed the inspector that there is a planned refurbishment/redecoration of resident’s bedrooms currently being planned. The CSCI also need to be informed of the changes proposed in respect of the position of registered manager within the home. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 6 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. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Prospective residents and their supporters are provided with the information they require to make informed choices about the suitability of the home. EVIDENCE: The home has produced a statement of purpose and service users guide that are readily accessible to all. Each resident had a copy of these documents which contained appropriate information and guidance for residents and have been updated to reflect changes in the management of the home. Detailed assessments of residents needs had been conducted on all the 5 residents prior to admission by a variety of health and social care professionals and by the senior staff at the home. These assessments ensure that the residents placement at the home is appropriate. Discussions with all the residents indicated that they were very much involved in the decision to live in the home. Prospective residents were able to visit the home as often as they wished prior to admission to meet the other residents and decided if the home was appropriate for them. A written contract of terms and conditions was in place for each resident at the home. Each resident was provided with a copy of those terms and conditions. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10. Residents are able to retain their individuality and ability to make personal choices that are important to them. EVIDENCE: Each resident has a detailed care plan – all of which had been recently fully reviewed. Indeed care records have been completely renewed and reorganised since the last inspection and were found to be comprehensive and well maintained. They contained information relating to residents personal/social history, physical health, mental health, diet, personal care, friends, family, social contacts, risk assessments and details of how residents were to be cared for and supported generally. There was evidence of continuing good links with other healthcare professionals, including mental health specialists, and of service users’ involvement in care planning and review. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 10 Residents confirmed that they are provided with encouragement and support and were enabled to make decisions about their own lives and day-to-day routines. Care records included risk management issues relevant to each individual in relation to decision making. Discussions with service users revealed that they felt that they were actively enabled and given the opportunity to participate in the day to day running of the home. Residents continue to be cared for in a very domestic and homely environment in which their views and input are important and valued. Risk assessments were detailed, individualised, and up to date, with review dates identified. Where appropriate risk management arrangements are agreed with the resident and other relevant agencies. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21. The home provides places for up to 5 residents in an environment that is ‘domestic’ and ‘homely’ in character that encourages a lifestyle that supports individual freedoms as much as possible. EVIDENCE: Resident’ users spoke positively in respect of being able to make decisions regarding the structure of their day and to participate in activities in which they are interested. It was evident that the new manager has focused on increasing group leisure activities within and out of the home to encourage residents to develop a greater sense of belonging. This has been achieved by introducing a range of outings that all can participate in. Discussion with residents indicated that these group activities have been well received. Staff are very active in providing support and reassurance in enabling participation in activities of daily living. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 12 Residents and staff report no unreasonable restrictions with regard to residents having contact with friends and family, unless a risk assessment suggests the need for such a restriction for the protection or welfare of a resident. Residents stated that their visitors continue to be made to feel welcome by staff. They also said that they are able to receive their visitors in the privacy of their own room if desired. Residents reported a high degree of satisfaction with meals provided. The dining room was adequately/appropriately furnished. There was flexibility in terms of when and where meals are taken. A full record of all meals taken by residents is maintained by the home The kitchen provided for the preparation of residents meals was found to be clean, appropriately equipped and to contain ample food stocks. Residents are able to access the kitchen for drinks and snacks when desired. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Residents are provided with, and are involved in developing methods of care and support that are appropriate to their needs as an individual. EVIDENCE: Inspection of care records and discussions with residents indicated that that the healthcare needs of residents are assessed and recognised, and that appropriate procedures are in place to address them. Staff, support and enable residents in attending appointments with a variety of health care professionals, including appointments with relevant specialists. All consultations with health care professionals at the home are conducted in private. The home uses a monitored dosage system for resident’s medicines. Medicines were securely and appropriately stored. One resident continues to self-medicate and has been provided with a lockable facility. Medication administration records were accurately completed and well maintained. Staff had received appropriate training in respect of resident’s medicines. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Appropriate measures have been taken to provide an environment where residents and their supporters feel comfortable with making a complaint if necessary, and to prevent residents becoming victims of abuse. These are important areas that are crucial to the protection of resident’s in a care home, many of whom are extremely vulnerable. EVIDENCE: Discussion with resident’s indicated that there was a general awareness and appropriate information provided that enabled people to make a complaint if they desired. Certainly residents spoken to expressed the view that they felt comfortable enough to raise concerns with the home’s management if they needed to and equally importantly were confident that any issues raised would be dealt with appropriately. Clearly such an approach by the home management means that the vast majority of concerns raised can be dealt with before they escalate into major issues – this can only be of benefit to residents at the home. A detailed and accessible complaints procedure was in place and prominently displayed in the home, which included details of how complainants could contact the CSCI if desired. Inspection of policies and procedures operated at the home and discussion with staff indicated that staff were aware of the importance of protecting resident’s from potential abuse and how to communicate any concerns they may have in this area. Staff training has been provided in respect of protection of vulnerable adults. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30. The home appeared to be structurally well maintained and to provide an appropriate environment for residents to receive personal care and accommodation. EVIDENCE: The inspector was informed that a programme of redecoration and refurbishment is currently being developed to improve the private accommodation of resident’s. However, at the time of this unannounced inspection the home was found to provide a clean, free of malodour, warm, comfortable and very homely environment for residents. Residents spoke very highly in respect of the accommodation provided for them. Resident’s bedrooms, of which 3 were inspected on this occasion, were appropriately/comfortably furnished and very personalised. Residents said they were actively encouraged to personalise their rooms with their own choice of pictures, ornaments etc. They also said they could access their rooms at any time. Adequate and suitable WC and bathing/shower facilities were provided in each bedroom. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 The home was providing adequate and appropriate staff to meet the needs of resident’s. EVIDENCE: Staffing provision at the home was found to comply with minimum guidelines and to be appropriate and adequate. Random inspection of 1 recently employed member’s of staff personnel file revealed that these contained an application form (including health declaration), 2 written references, a Criminal Records Bureau check (including a ‘POVA first’ check), proof of identity (including a photograph), and evidence of induction and further training. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43. The home was being appropriately managed at the time of this inspection. EVIDENCE: A new manager has been appointed since the last inspection. This person will be undergoing the legally required process of registration with the CSCI. Discussions with resident’s indicated that the home is managed in a way that is open and positive. Management was said to be accessible and responsive to issues raised. The newly appointed manager has nearly completed NVQ4 training in management and care. Residents manage their own finances. A signed record that personal allowances had been paid to residents was maintained. Residents confirmed that they had access to this money and could spend it freely. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 18 The following safety/servicing certificates were inspected at the time of inspection and found to be up to date; Yearly gas safety certificate, servicing of fire safety equipment and the fire alarm system, the 5 yearly NIEIC electrical safety certificate and the safety of portable electrical appliances within the home. Accidents that occur in the home were appropriately recorded and had been appropriately managed. Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Southlea Residential Care Home Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 3 DS0000061330.V256770.R01.S.doc Version 5.0 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 37 Regulation 8 and 9 Requirement That the CSCI is informed in writing what the position is in relation to the person who/is to be the registered manager of the home That the CSCI is informed in writing of any proposed changes to the environment of resident’s bedrooms Timescale for action 30/11/05 2 26 23 30/11/05 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 Standard Good Practice Recommendations Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Southlea Residential Care Home DS0000061330.V256770.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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