Inspection on 06/02/06 for Together Working for Wellbeing (Southbury Road)

This inspection was carried out on 6th February 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Together Working for Wellbeing... 05/11/07

Together Working for Wellbeing... 31/07/06

Together Working for Wellbeing... 20/09/05

Together Working for Wellbeing... 10/01/05

Together Working for Wellbeing... 08/06/04

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

CARE HOME ADULTS 18-65 Together Working for Wellbeing (Southbury Road) 87 Southbury Road Enfield Middlesex EN1 1PJ Lead Inspector Brian Bowie Unannounced Inspection 08:30 6 February 2006 th Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.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 Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.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. Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 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.V265657.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th September 2005 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 maintain and develop their independence. Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 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 5 hours. The manager was present throughout and assisted with the inspection. The home was looked round and 6 of the 8 people resident in the home at the time of the inspection were spoken to in order to get their views about the home. At the time of the inspection there was one vacancy. Care staff on duty were spoken to and the handover session between the night and morning shift was observed. 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 has achieved a good standard of care over a long period of time within a friendly, homely and supportive environment, and which is now aiming for still higher standards of care. What the service 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 and motivated 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. Residents help to get the weekly shopping for the home and one resident has a special responsibility to take prescriptions into the local GP surgery. The home supports residents to maintain links with their families and relatives, with one resident visiting his family on the day of the inspection. The staff team has built up good links with other professionals which helps to ensure that residents’ needs are regularly reviewed and their difficulties responded to promptly and effectively. Southbury Road is a spacious house which is furnished and decorated to a good standard. As a result residents benefit from living in a homely, comfortable and clean living environment. Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 5 new areas for improvement are identified at this inspection. These include: • • • • • Residents to be as actively involved in the running of the home as possible All risk assessments to be dated, and reviewed and updated regularly The health and safety risk assessment of the premises to be reviewed and updated The cupboard in the laundry containing cleaning materials to be kept locked An up-to-date fire safety risk assessment of the premises together with an emergency plan to be made, both of which to be approved by the London Fire Emergency Planning Authority In general care the home needs to strengthen its procedures in relation to recording and reviewing the areas concerning risk and safety in the home. This is becoming more important as the home moves towards supporting residents with higher and more complex needs. 2 recommendations to improve practice further are made in relation to medication and involving residents more in reviewing and improving the service. The 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. Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 7 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.V265657.R01.S.doc Version 5.0 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.V265657.R01.S.doc Version 5.0 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): 2 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. EVIDENCE: Interviews with the manager and staff confirmed that in most cases residents were settled in the home and considered that their needs are being met. The case records looked at showed that the needs and wishes of residents are individually assessed and detailed care plans drawn up. The manager confirmed that she visits prospective residents before they move in and that they are able to visit the home before moving in. A trial period is then offered so that residents and the home can make an informed decision as to whether Southbury Road is the appropriate placement for the individual concerned. Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 10 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): 7,8,9 Residents are supported by staff so that they can make lots of decisions for themselves. The home needs to extend further the opportunities residents have to contribute to the running of the Southbury Road. The process for assessing and reviewing risks in relation to residents needs improvement. EVIDENCE: Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 11 Care plans reflect the wide range of areas where residents make choices. 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 held to give opportunities for residents to contribute their ideas and views on how the home is run. However for a number of reasons these meetings are not always held regularly. The manager must ensure that reasons for cancelling or not recording meetings are clearly recorded so that the home can demonstrate that it is working hard at getting the residents to be as actively involved in the running of the home as possible. Information is gathered prior to admission from professionals involved with the service user on any areas of risk. Care plans sampled contained risk assessments. However risk assessments seen were not clearly dated, nor was there sufficient evidence of a rigorous process in the home to ensure that all risk assessments are regularly reviewed and updated. In one case a risk assessment relating to a resident who smoked in their bedroom had not been updated. The manager must ensure that all risk assessments are dated, and reviewed and updated regularly. This is particularly important if, as planned, people with higher and more complex needs are admitted to the home. Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 12 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): 12,16,17 The home is good at enabling residents to get out and about and lead as ordinary a life as possible. Residents benefit by having staff who allow them to make choices for themselves and to have as much control over their life as possible. Residents enjoy their meals and benefit from being offered a healthy diet. EVIDENCE: Residents take part in a variety of daytime activities, including day centres and work projects. Residents get out and about in their local community, including going shopping, to the cinema and on outings. As a result residents have the opportunity to participate in and be part of the local community. 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 Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 13 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. One of the residents explained that residents plan the menu for each week and choose the meals they wish to eat. The residents help staff with the household shopping and, 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.V265657.R01.S.doc Version 5.0 Page 14 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): 18,20 Staff are good at supporting the residents in a way that they are happy with. Residents are protected by the thorough procedures in place in the home in relation to medication. EVIDENCE: The home has detailed care plans in place describing how staff support residents to get the needs and wishes met. 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. Two residents said staff had helped them to become more independent since moving in. The home is encouraging and enabling residents to take more responsibility for taking their medication. In one case a resident is responsible for their own medication and the home checks that this is being done properly. Medication records seen were accurate and up to date. It is recommended that a record is made on the administration sheet to indicate when the person is due to have their medication by injection from the community psychiatric nurse and when Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 15 this has been given so that a clear record is maintained by the home of this aspect of the resident’s medication regime. Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 16 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. EVIDENCE: The home has policies and procedures in place in relation to reporting and investigating complaints. The complaint record indicated that one complaint had been made since the previous inspection. This complaint had been investigated and recorded appropriately. One resident said: ‘I like it here. I’ve no complaints.’ There had been no incidents in relation to adult protection in the home in the last year. Staff have had training in this area and know how to respond to incidents or allegations. The home has a copy of the L.B. of Enfield’s adult protection guidelines. Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 17 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 which adds considerably to their quality of life. EVIDENCE: The home provides a comfortable and homely environment which 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. A cleaner comes in each weekday to ensure the home is kept clean and tidy. On the day of the inspection the home was being cleaned to a good standard. At weekends the residents themselves share the responsibility for keeping the home clean and tidy. Feedback from staff indicated that residents help with the cleaning at weekends. Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Residents benefit from a committed and experienced team of staff at the home who have the skills and training to meet their needs. Residents are protected by the home having proper recruitment procedures for new staff. EVIDENCE: Staff on duty throughout the inspection were observed and spoken to. The handover from the night to morning shift was observed which indicated that staff have built up a good knowledge and understanding of the needs of each resident. A good deal of positive feedback was received from the residents, including: ‘I like it here- they help me when I need it.’ The staff rota showed that the home has sufficient staff on each shift 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. Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 19 Care staff undertake NVQ Level 2 and Level 3 training in caring for people in order to improve their care practice. Staff also attend Together’s own courses, including essential areas such as food hygiene, health and safety, administering medication and first aid, as well as courses on working with people with mental health needs. As a result staff have a good understanding of the individual needs of each resident. Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 The home runs well so that the residents really benefit by living at Southbury Road and by having their individual needs and wishes responded to. The home is good at responding to comments and suggestions from residents about how the home is run. Residents need to have the full protection provided by the home having an up-to-date fire safety risk assessment together with an emergency plan for evacuation of the buildings, and by rigorous health and safety procedures. EVIDENCE: The manager and her staff team are committed to improving further the standard of care provided for residents and ensuring it is based on a holistic and person-centred approach, which aims to meet the individual needs and wishes of each resident, and which reflects current thinking about what is best practice in the mental health area. The manager, Jackie Osei, is knowledgeable and perceptive about the needs of residents. As a result what the residents get out of the home is a caring and supportive place to live where Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 21 they are being helped to get as much as possible out of life, and where their independence skills are developed as far as possible. 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. It is recommended that the home and area manager explore ways of further empowering residents in the running of the home and the opportunities they have to shape how the home is run. Health and safety records were looked at and in general were satisfactory. However the risk assessment of the premises needs reviewing and updating and action taken to ensure the cupboard in the laundry containing cleaning materials is kept locked. 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. However in line with guidance from the LFEPA the home must have an up-todate fire safety risk assessment of the premises together with an emergency plan which sets out how the building is to be evacuated in the event of a fire. Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 2 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 3 x Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 x Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA8 Regulation 24 (3) Timescale for action The registered persons must 28/02/06 ensure that residents have regular opportunities to be as actively involved in the running of the home as possible. The registered persons must 28/02/06 ensure that all risk assessments are dated, and reviewed and updated regularly. The registered persons must 28/02/06 ensure that the health and safety risk assessment of the premises is reviewed and updated. The registered persons must 28/02/06 ensure that the cupboard in the laundry containing cleaning materials is kept locked. The registered persons must 28/02/06 ensure that Southbury Road has an up-to-date fire safety risk assessment of the premises together with an emergency plan, both of which have been approved by the London Fire Emergency Planning Authority. Requirement 2 YA9 13 (4) (b) 3 YA42 23 4 YA42 13 (4) 5 YA42 23 (4) Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 24 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 YA20 Good Practice Recommendations The registered persons should ensure a record is made on the medication administration sheet to indicate when a resident is due to have their medication by injection from the community psychiatric nurse and when this has been given so that a clear record is maintained by the home of this aspect of the resident’s medication regime. The registered persons should ensure that further ways are found of empowering residents in the running of Southbury Road and increasing the opportunities they have to shape how the home is run. 2 YA39 Together Working for Wellbeing (Southbury Road) DS0000010664.V265657.R01.S.doc Version 5.0 Page 25 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.V265657.R01.S.doc Version 5.0 Page 26 - 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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