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Inspection on 31/07/06 for Together Working for Wellbeing (Southbury Road)

Also see our care home review for Together Working for Wellbeing (Southbury Road) for more information

This inspection was carried out on 31st July 2006.

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 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 10 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

`I liked the support from staff. I liked mixing with other people- I made some friends. I enjoyed doing my own cooking. Staff helped me to be more confident and more independent, otherwise I couldn`t have got back to my own flat. They started with teaching me to manage my own medication, then I collected my prescription.` This feedback from a resident who had just moved on from the home summarises what Southbury Road does well. Residents feel at home and relaxed at Southbury Road because staff pay close attention to meeting their individual needs and wishes. The majority of the residents spoken to said they enjoyed living at the home and were happy with the quality of care they were getting. One resident said: ` I came here from hospital. I`ve got on well. The staff have helped me to settle in and get more independent.` There is an experienced team of staff at the home. As a result residents benefit from being supported by staff who have got to know them well and who can respond appropriately to their needs and wishes. As a result residents are maintaining and improving their independence skills in areas such as cooking, shopping, cleaning, budgeting and socialising in the community. The home supports residents to maintain links with their families and relatives, with residents visiting their families on the day of the inspection. The staff team has built up good links with other mental health professionals so that residents` difficulties are responded to promptly and effectively.

What has improved since the last inspection?

The home had responded positively to the last inspection so that 4 of the 5 areas which needed attention had been sorted out. The input from the multi-disciplinary team, including psychiatrist, social workers and therapists, had increased so that residents having mental health difficulties are more effectively supported. After a difficult period staff morale is improving.

What the care home could do better:

CARE HOME ADULTS 18-65 Together Working for Wellbeing (Southbury Road) 87 Southbury Road Enfield Middlesex EN1 1PJ Lead Inspector Brian Bowie Key Unannounced Inspection 31st July 2006 10.30 Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.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 Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.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. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Together Working for Wellbeing (Southbury Road) 87 Southbury Road Enfield Middlesex EN1 1PJ 020 8342 1593 020 8362 9004 Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.together-uk.org Together Working for Wellbeing Jacqueline Konadu Osei Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2006 Brief Description of the Service: Southbury Road is managed by Together: Working for Wellbeing (formerly MACA), which provides services throughout the country for people with mental health problems. The home accommodates nine residents. There are three bedrooms on the ground floor and six bedrooms on the first floor. The home is wheelchair accessible. There is an adapted bathroom and toilet on the ground floor. The building has a lounge, dining room and kitchen. There is a separate laundry and a spacious garden to the rear of the building. The home is within walking distance of the local shops. There are good public transport links. The home aims to provide a supportive environment where residents can develop their independence and move onto alternative accommodation. Fees at the time of the inspection were £600/week approx. Together makes available to residents and families inspection reports and information detailing the service provided by Nightingale Road. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and lasted 7.5 hours. The acting manager was present throughout and assisted with the inspection. (The registered manager had been suspended by Together at the time of the inspection). The home was looked round and 5 of the 9 people resident in the home at the time of the inspection were spoken to in order to get their views about the home. A resident who had recently moved on from the home was also interviewed. At the time of the inspection there was one vacancy. Care staff on duty and a support therapist from the local community mental health team were interviewed. A member of Together’s ‘User Involvement’ team who was interviewing residents was also spoken to. A variety of records, including care plans, risk assessments and health & safety documents, were looked at. The overall impression from the inspection was of a home that had been going through a difficult period following the suspension of the manager. As a result the overall standard of care had decreased from good to adequate. At the inspection there were indications that standards were beginning to increase again. Given an appropriate response to the identified areas needing attention and the establishment of secure management arrangements Southbury Road has the potential to achieve once more a good standard of care. What the service does well: ‘I liked the support from staff. I liked mixing with other people- I made some friends. I enjoyed doing my own cooking. Staff helped me to be more confident and more independent, otherwise I couldn’t have got back to my own flat. They started with teaching me to manage my own medication, then I collected my prescription.’ This feedback from a resident who had just moved on from the home summarises what Southbury Road does well. Residents feel at home and relaxed at Southbury Road because staff pay close attention to meeting their individual needs and wishes. The majority of the residents spoken to said they enjoyed living at the home and were happy with the quality of care they were getting. One resident said: ‘ I came here from hospital. I’ve got on well. The staff have helped me to settle in and get more independent.’ There is an experienced team of staff at the home. As a result residents benefit from being supported by staff who have got to know them well and who can respond appropriately to their needs and wishes. As a result residents are maintaining and improving their independence skills in areas such as cooking, shopping, cleaning, budgeting and socialising in the community. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 6 The home supports residents to maintain links with their families and relatives, with residents visiting their families on the day of the inspection. The staff team has built up good links with other mental health professionals so that residents’ difficulties are responded to promptly and effectively. What has improved since the last inspection? What they could do better: 10 areas for improvement are identified at this inspection including one not met from the previous inspection. This area, relating to risk assessments, has been restated in this report, with a new timescale for compliance. Further information about unmet requirements can be found in the relevant section. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. In order to ensure the needs of residents are met at all times Together must ensure: • The statement of purpose and service user guide are updated to reflect Southbury Road is now a home for people with higher mental health needs with an emphasis on moving people on to alternative accommodation Each resident has a monthly meeting that is recorded in order to review and respond to changing needs. Residents’ risk assessments are reviewed and updated regularly Each resident has a drug profile on file that records current medication and guidance concerning any prn usage, which is authorised by the psychiatrist All care staff have undertaken training in adult protection DS0000010664.V298796.R01.S.doc Version 5.2 Page 7 • • • • Together Working for Wellbeing (Southbury Road) • • • • The rear garden is kept in good order A training profile is devised for each member of staff detailing training undertaken and training needs not yet met all staff working at Southbury Road to have supervision meetings at least 6 times/annum. Sufficient numbers of managerial and senior staff are in place at Southbury Road so that residents have the benefit of a home that is run well at all times The fire safety risk assessment for Southbury Road together with the emergency plan are approved by the LFEPA (London Fire Emergency Planning Authority) • 2 recommendations to improve practice further are made: • • Rear garden to be developed as a resource for residents who enjoy gardening and being in the garden All staff to be trained in person-centred planning to strengthen Together’s efforts to improve how Southbury Road is run The acting manager emphasised that she and her staff team are keen to work closely with CSCI to raise standards further at the home in order to be able to provide the best possible quality of life for residents. 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. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.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 Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 The home is good at ensuring people moving into the home have their needs and wishes assessed so that the home can be confident that it can meet these needs and wishes. Southbury Road is good at enabling prospective residents to visit and have trial stays at the home before they decide if they want to move in. Information about the home for new residents is detailed and informative, but needs updating to reflect Southbury Road‘s changing role. EVIDENCE: Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to this service. ‘This person has made positive progress at Southbury Road, and says they’re happy living at the home.’ This comment comes from a CPA ( Care Programme Approach) review on a resident who had recently moved into Southbury Road. 2 residents who had recently moved into the home were spoken to and indicated they were reasonably happy living at Southbury Road. The acting manager confirmed that staff at the home were working even more closely with the local CMHT (community mental health team) now that people with more complex needs were being placed at the home. The assessment form used by Southbury Road has a section on religious or cultural practices so that these needs can be identified and responded to. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 10 One person was on a trial stay at the home. The support therapist from the CMHT commented: ‘This individual was keen to leave hospital. They’re very happy here. When they wanted to they came for visits, including meals. They’re now making friends at Southbury Road.’ Information about the home for new residents is detailed and informative, but needs updating to reflect Southbury Road ‘s move to providing support for people with higher and more complex mental health needs and the increased emphasis on moving people on after a period of rehabilitation. Together must ensure that the statement of purpose and service user guide are updated to reflect this change. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Residents benefit by having care plans that set out clearly and in detail how their needs and wishes will be met by the home. Residents are enabled by staff to make lots of decisions for themselves. The process for assessing and reviewing risks in relation to residents needs urgent improvement. EVIDENCE: Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to this service. ‘All Together’s services are based on the needs of the people who use them and we value the diversity of people who use and deliver our services.’ The care plans sampled were detailed and covered the key aspects of the resident’s life, including diversity issues. There was positive written feedback from professionals involved with the home, including social workers and community psychiatric nurses, which indicated residents are progressing at Southbury Road. Staff have 1-to-1 meetings with the residents for whom they are the ‘keyworker’. Notes of these meetings were seen and showed how aims listed in the care plan are being followed through by staff. However recent staffing Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 12 changes in the home had resulted in some residents losing their keyworker and not being assigned a new one so that regular meetings to review the resident’s needs had not taken place. The acting manager must ensure that each resident has a monthly meeting that is recorded in order to review and respond to changing needs. ‘When I first came here I didn’t do too much, after a while I started making my own decisions.’ This was the comment of a resident who had recently moved on from Southbury Road. Residents choose when they have their meals and when they go out. On the day of the inspection residents chose themselves whether they wanted to go out, and if they stayed at home how they were going to spend their time. As a result residents have become more confident and more able at making their own decisions about how they lead their life. When residents say they want to move on from Southbury Road this is discussed by staff and where appropriate meetings held with relevant professionals. Residents’ meetings are also held to give opportunities for residents to contribute their ideas and views on how the home is run. Care plans sampled contained risk assessments. However there was insufficient evidence of a rigorous process in the home to ensure that all risk assessments are regularly reviewed and updated. In the case of 2 new residents updated risk assessments had not been made whilst further information was awaited. In these circumstances a risk assessment must still be made and then updated in the light of additional information. The acting manager and service manager must ensure that there is a rigorous process in the home of reviewing and updating risk assessments in order that residents are properly protected. This is especially important with residents with more complex needs being placed in the home. This requirement is restated and compliance is expected within the timescale given. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 The home is good at enabling residents to get out and about and lead as ordinary a life as possible. Residents are getting a better quality of life because of the good links with the local community, the range of leisure activities available and the close contact residents have with friends and family. Residents benefit by having staff who respect their rights and encourage them to act responsibly. Residents enjoy their meals and benefit from being offered a healthy diet. EVIDENCE: Quality in this outcome area is good. This judgement has been made from evidence gathered during the visit to this service. ‘I liked mixing with other people- I made some friends. I enjoyed doing my own cooking. Staff helped me to be more confident and more independent, otherwise I couldn’t have got back to my own flat. They started with teaching me to manage my own medication, then I collected my prescription.’ This was the very positive experience of one resident who had recently moved on from Southbury Road. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 14 A resident confirmed that they got out and about: ‘I go to Tesco’s, Chase Farm Hospital.’ ‘Some residents get bored with the same routine, but then they don’t help themselves.’ This was the view of one former resident. On the day of the inspection residents and a member of staff played scrabble, whilst other residents were out shopping or visiting family. I enjoy gardening and the help I’m getting with it.’ One resident was seen with the therapist from the CMHT doing some gardening and clearly enjoying this activity and taking pride in the bowls she had planted out. The therapist confirmed that the CMHT has close links with employment services, colleges and day centres so that residents have opportunities to try these things out if they wish to. Feedback from residents was positive about how staff respect their rights and give them responsibility. One resident has the responsibility of taking prescriptions to the local surgery. Residents also assist with getting the weekly shopping for the home. At the weekend residents help to keep the home clean and tidy. Consequently residents are developing their skills so that they are able to be as independent as possible. ‘I cook one day a week-this week I’m doing a curry.’ This was the comment of one resident, and reflected the fact that cultural food preferences of residents were being responded to. Throughout the inspection residents used the kitchen to make themselves drinks or snacks. One of the residents explained that residents plan the menu for each week and choose the meals they wish to eat. The residents, with the assistance of staff if required, prepare the meals. If a resident does not like a particular meal an alternative is offered. Mealtimes are relaxed and flexible to suit the needs of residents. Residents said that they liked being able to choose when and where to eat their meals. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Staff are good at supporting the residents in a way that they are happy with. Staff are good at meeting the physical and health needs of residents. Residents are protected by the thorough procedures in place in the home in relation to medication. EVIDENCE: Quality in this outcome area is good. This judgement has been made from evidence gathered during the visit to this service. ‘My keyworker’s very nice- she’s nice to talk to.’ This was the comment of one resident. Each resident has a member of staff who has a special responsibility to meet regularly with the resident on a one-to-one basis in order to respond to and meet their individual needs. Staff interviews indicated that staff had a good understanding of each resident’s needs and were working hard to meet these needs and wishes. Notes of CPA meetings confirmed that other mental health professionals considered that residents were progressing at Southbury Road and achieving a more fulfilling lifestyle than previously. ‘They started with teaching me to manage my own medication, then I collected my prescription.’ One resident explained how he had learnt to self-administer their medication as part of a programme to enable the individual to move on Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 16 from Southbury Road to more independent accommodation. Medication records were accurate and up to date. Thorough procedures are in place to ensure that residents have their medication reliably as prescribed. In order to improve procedures further each resident must have a drug profile on file that records current medication and guidance concerning any prn usage and which is authorised by the psychiatrist. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The home has good complaints and adult protection procedures so that residents and relatives feel confident complaints and incidents will be listened to and acted on. However residents do not have the full protection afforded by having all members of care staff having undergone training in adult protection. EVIDENCE: Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to this service. ‘Problems were sorted out promptly.’ ‘I haven’t got any problems at the moment.’ These were the views of 2 residents and indicates that the home responds well to concerns from residents. Together as an organisation takes diversity issues seriously. The statement of purpose states: ‘All Together’s services are based on the needs of the people who use them and we value the diversity of people who use and deliver our services. If you have a complaint of discrimination or victimisation, we advise you to follow the complaints procedure.’ ‘I’m not aware of any adult protection incidents during the year I’ve worked at the home.’ This was the view of one member of staff. There had been no recorded incidents in relation to adult protection in the home in the last year. However the 2 care staff interviewed said they had not attended any adult protection training. The acting manager must ensure that all care staff have undertaken training in adult protection. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Residents at Southbury Road enjoy an attractive, comfortable and clean living environment that adds considerably to their quality of life. However residents do not have the benefit of a rear garden that is well maintained. EVIDENCE: Quality in this outcome area is good. This judgement has been made from evidence gathered during the visit to this service. ‘It’s ok here- I would have preferred my own flat. It’s ok sharing with others. My room’s ok- I’ve got my own TV.’ This was the view of one resident. The home provides a comfortable and homely environment that meets the needs of the current group of residents. Throughout the inspection it was noted that residents were very comfortable and relaxed in the home. An extension to the downstairs area means that residents with mobility difficulties can be accommodated on the ground floor. The rear garden was in need of maintenance with some areas overgrown. This area must be kept tidy so that it presents an attractive and usable area for residents. On the day of the inspection one resident was getting particular pleasure from being supported to do some gardening. It is recommended that Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 19 the garden is developed further as a resource for residents who enjoy gardening. ‘The cleaner comes in Monday to Friday mornings. At weekends the residents help out with specific jobs. I help clean the bathroom at weekends and wash the tablecloths.’ A resident confirmed the cleaning arrangements in place in the home. On the day of the inspection the home was being cleaned to a good standard. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Residents are supported by a sufficient number of competent and experienced staff. Together has sound policies and procedures in place in relation to the recruitment of new staff. Residents do not have the benefit of a staff that are well trained and supervised. EVIDENCE: Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to this service. ‘I’m very grateful for the support from the staff. At first I thought they might send me back to hospital. They are very patient with me. They persevered and it paid off.’ ‘Staff help me to iron out problems. All the staff are ok.’ These comments reflected the general view of residents spoken to. Staff on duty throughout the inspection were seen to support residents appropriately. Staff at the home undertake relevant training courses, such as the NVQ Level 2 & 3 in caring for people so that they are able to support residents more effectively. ‘The staffing level is fine, 2 staff on with the acting manager as a 3rd person is sufficient.’ This was the view of one member of staff. Together was recruiting to vacant posts at the time of the inspection. These posts had been covered recently by Together’s team of bank staff. Staffing levels had been increased Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 21 at night so that there is a waking night member of staff, as well as a member of staff who sleeps in. At the time of the inspection staffing levels were sufficient to meet the needs of the current group of residents. Files for new staff were looked at and contained the information needed to make sure that staff in the home have the appropriate checks made. These checks include obtaining written references and a satisfactory CRB disclosure. These procedures help to ensure that residents are protected from having unsuitable staff working in the home. The acting manager said that the current round of recruitment included a focus on achieving a more ethnically diverse staff team which would better reflect the ethnic make up of the current group of residents. Staff interviews indicated some gaps in their training, including adult protection. A training profile must be devised for each member of staff detailing training undertaken and training needs not yet met, including essential training courses to be undertaken. Staff interviews and subsequent discussion with the acting manager indicated that staff are not having regular 1-to-1 meetings with the acting manager to provide support and develop their skills further. The acting manager must ensure all staff working at Southbury Road have supervision meetings at least 6 times/annum. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Together has failed to ensure that Southbury Road is run effectively at all times. Members of staff are good at responding to and acting on comments and suggestions from residents about how the home is run. The home has good procedures in place in relation to health and safety that help to ensure residents are protected at all times. However residents need to have the full protection provided by the home having a fire safety risk assessment together with an emergency plan for evacuation of the building that have been approved by the LFEPA. EVIDENCE: Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to this service. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 23 In May 2006 Together suspended the registered manager and a senior member of staff. At the time of the inspection Together had not concluded its investigations following these suspensions. Interim the deputy manager had been acting as manager with additional back up from the service manager. Since May 2006 the management resources in the home have been stretched. Despite the best efforts of the acting manager the previous high standards maintained by the home had decreased. As a result a number of failings in how the home is run were identified at this inspection. Together must ensure there are sufficient numbers of managerial and senior staff in place at Southbury Road so that residents have the benefit of a home that is run well at all times. Residents, individually and as a group, put forward their ideas and suggestions on how the home is run and these are then followed up by staff, such as organising an outing, the menu for the following week, which days people do their washing and cooking the evening meal. The area manager for Together visits the home monthly to check how it is doing and identify areas for improvement. Residents, families and professionals are asked for their comments and suggestions on improving further the quality of care in the home. During the inspection staff from Together’s ‘User Involvement’ team were interviewing residents to get their comments and views on what contributed to their wellbeing. It is recommended that all staff are trained in person-centred planning to strengthen Together’s initiatives in this area. Health and safety records were looked at and were satisfactory. Fire safety records were up-to-date and accurate and confirmed that the home is being run responsibly with statutory checks being made and acted on. As previously required the home had updated its fire safety risk assessment and its evacuation plan. The acting manager must now ensure these documents are approved by the LFEPA. Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 24 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 X 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000010664.V298796.R01.S.doc 2 3 X 1 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 X 3 X X 2 x Version 5.2 Page 25 Together Working for Wellbeing (Southbury Road) Yes 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 YA1 Regulation 4 (1) (a) Timescale for action The registered persons must 30/09/06 ensure that the statement of purpose and service user guide are updated to reflect that Southbury Road is now a home for people with higher mental health needs with an emphasis on moving people on to alternative accommodation The registered persons must 30/09/06 ensure that each resident has a monthly meeting that is recorded in order to review and respond to changing needs. The registered persons must 30/08/06 ensure that residents’ risk assessments are reviewed and updated regularly. Restated Requirement The registered persons must 30/09/06 ensure that each resident has a drug profile on file that records current medication and guidance concerning any prn usage and which is authorised by the psychiatrist. The registered persons must 30/10/06 ensure that all care staff undertake training in adult protection. DS0000010664.V298796.R01.S.doc Version 5.2 Page 26 Requirement 2 YA6 15 (2) (b) 3 YA9 13 (4) (b) 4 YA20 13 (2) 5 YA23 13 (6) Together Working for Wellbeing (Southbury Road) 6 7 YA24 YA35 23 (2) (o) 18 (1) (c) 8 YA36 18 (2) 9 YA37 18 (1) (a) 10 YA42 23 (4) The registered persons must ensure that the rear garden is properly maintained. The registered persons must ensure that each member of staff has a training profile detailing training undertaken and training needs not yet met, including essential training courses to be undertaken. The registered persons must ensure that all staff working at Southbury Road have supervision meetings at least 6 times/annum. The registered persons must ensure that there are sufficient numbers of managerial and senior staff in place at Southbury Road so that residents have the benefit of a home that is run well at all times. The registered persons must ensure that Southbury Road’s fire safety risk assessment and its emergency plan are approved by the LFEPA. 30/09/06 30/09/06 30/09/06 31/08/06 30/09/06 Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations The registered persons should ensure the rear garden is developed as a resource for residents who enjoy gardening and being in the garden. The registered persons should ensure all staff are trained in person-centred planning. 2. YA39 Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Together Working for Wellbeing (Southbury Road) DS0000010664.V298796.R01.S.doc Version 5.2 Page 29 - 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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