Inspection on 12/06/08 for Townley Road, 2-3

This inspection was carried out on 12th June 2008.

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

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

Townley Road, 2-3 24/08/06

Townley Road, 2-3 04/01/06

Townley Road, 2-3 14/10/05

Townley Road, 2-3 24/03/05

Townley Road, 2-3 14/12/04

Townley Road, 2-3 11/03/04

Similar services:

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Ashwood House (Leyton)

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Townley Road, 2-3 East Dulwich London SE22 8SW Lead Inspector David Halliwell Key Unannounced Inspection 12th June 2008 09:30 Townley Road, 2-3 DS0000007000.V363087.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 Townley Road, 2-3 DS0000007000.V363087.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. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Townley Road, 2-3 Address East Dulwich London SE22 8SW 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) 020 8299 1841 020 8299 0820 townley_road@hexagon.org.uk Hexagon Housing Association Ms Norma Smellie Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 10 24th August 2006 Date of last inspection Brief Description of the Service: Townley Road is a care home providing care, nursing and accommodation to ten service users with mental health needs. It aims to provide placements of two to three years to enable service users to move on to a range of other housing options. The home is owned and run by Hexagon Housing Association The home is located in East Dulwich, close to the train station, shops, banks, a post office and bus services. The home is a three storey residential building with bedrooms on the first and second floors. All bedrooms are single. There is a communal lounge, dining/games area and quiet room along with a large kitchen. There is a small kitchenette on the first floor. There is no passenger lift and the home is not wheelchair accessible. There is a garden to the rear. At the time of this inspection there were no vacancies at the home. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 3 stars. This means the people who use this service experience excellent outcomes. Service users said that they like to be called residents. This was an unannounced inspection visit of the service at 2-3, Townley Road. The Inspection covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with 3 staff and the Manager and 4 of the 10 residents. A completed AQAA was received prior to the inspection. No enforcement activity has occurred since the last inspection. There have not been any changes in the ownership or management of Townley Road, Hexagon Housing Association remain the provider agency. The Manager is registered with the Commission for Social Care Inspection as the Manager. No requirements have been made as a result of this inspection. 4 good practice recommendations have however been made. Feedback on the recommendations was fully explained to the Manager at the end of the inspection visit. We found the residents and staff most helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. We were very impressed by the commitment and enthusiasm of the Manager and of the staff group and of the quality of the services being provided at Townley Road. The Manager told us that the cost of a placement at Townley Road is £1432.50 per week. What the service does well: The home is able to demonstrate that it is assessing and meeting the needs of service users admitted to the home. Prospective service users, their relatives and friends are able to visit and to assess the quality, facilities and suitability of the home. The health and social care needs of service users are being well met. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 6 Service users are living in a safe, well-maintained environment, with access to safe, pleasant and comfortable facilities. Service users presented as being well settled and very happy in their environment and very satisfied with the staff, their care support and the communal and personal facilities provided. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 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 Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 was inspected at this inspection. People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective service users may be fully assured that their needs are assessed and that their individual aspirations and wishes will be taken into account in the assessment process. EVIDENCE: Standard 2 – Since the last inspection in 2006 8 new residents have been admitted and the home is now full with a total of 10 residents. We reviewed the files of 4 of the residents and found that all had received a full and comprehensive pre-admission needs assessment that was carried out with skill and sensitivity by the Manager or the Deputy Manager with regards to the needs of the people concerned. The Manager told us that they ensure a needs assessment and care plan is obtained from the referring authorities for each new resident placed at Townley Road. Evidence of this was seen by us on the resident’s files. The completed AQAA also confirms this and it says, “… that the Registered Person or the Deputy Manager carries out a full assessment using an appropriate assessment tool for all potential new residents”. The combined information from these sources form a comprehensive information Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 9 base for each resident from which accurate and relevant care plans can be drawn up. The Manager explained to us that the needs assessment process is about ensuring that staff can meet the identified needs of the prospective resident in that they have the appropriate skills, training and knowledge to enable them to do so. Before agreeing any admission the Manager allocates a key worker to each resident who will work with them on developing the home’s care plan and making sure it meets the identified needs. Both the Manager and information in the AQAA confirmed that each key worker is a registered nurse. Residents were seen by us to have been involved in the assessment process having had the opportunity to express their wishes and preferences and to comment on their identified needs. Signatures of the residents and dates were seen on the assessment paperwork confirming their involvement in the process. Family and close relationship needs of the resident’s files inspected had been included in the assessment and care planning processes. When we spoke with one of the residents it was clear from what she told us that she had been and is still fully involved in the process and that she is very satisfied with the outcomes of her care package at Townley Road as a result. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, & 9 were inspected at this inspection. People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents may be assured that their assessed and changing needs and personal goals will be reflected in their care plans. They may also be assured that they will be able to make decisions about their daily lives and be enabled to take risks as part of developing a more independent lifestyle with support, as they need it. EVIDENCE: Standard 6 – through the course of this inspection it became clear that the central focus of the services provided at Townley Road is on the residents and how their needs, wishes and preferences can be most effectively be met where-ever possible. Residents were seen to be fully involved in the needs assessment and care planning processes. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 11 Care plans seen were based on the needs assessments that had been drawn up both from the Care Programme Approach needs assessment and Townley Road’s own needs assessment. Inspection of the care plans evidenced this and we were impressed with the quality of the care plans seen. They had been clearly divided into sections (relating to the identified needs) with care plan objectives and action plans which addressed the needs and set out identified milestones with review dates, so that clear monitoring and review could then be achieved. 3 monthly reviews by the care staff team were evidenced on the files and involvement of each of the residents in these reviews was also evident. They confirmed their involvement in the review and care planning process at interview with us. Inspection of the review reports showed that changing needs of residents had been identified and that appropriately revised care plan objectives had been drawn up together with the resident. Key workers were seen to actively provide 1:1 support; to revise the care plans as necessary and to keep the residents informed. Formal 6 months reviews are planned and held with the clinical teams and the residents. The residents have their own key workers and the Manager told us that residents can choose their key workers if they wish. Residents confirmed to the Inspector that they are happy with their key workers and find them helpful, supportive and friendly. Standard 7 – Over the course of this inspection we saw that staff asked residents what they wanted to do and to make decisions about their daily lives. The Manager told us that residents do have their own residents meetings every week, called Community Meetings, and that meetings are minuted. The minutes of these meetings were shown to us by the Manager. The records show that meetings are held weekly, they indicate who has attended the meetings and what issues have arisen and discussed. This means that residents are enabled to make decisions about their lives with assistance as needed. Standard 9 – The care planning process includes the use of risk assessments that were seen and inspected on each of the 4 resident’s files. They are evidently used as a pre-admission assessment tool and following admission, being used to assist residents to be appropriately supported to take risks as a part of developing a more independent lifestyle wherever possible. Any identified risks are managed positively to help the residents lead the sort of lives they aspire to as much as is realistically possible. These risk assessments are agreed with the resident and the relevant professionals who both sign the risk assessment form. This all helps residents to be assured that they will be supported to take risks as part of developing a more independent lifestyle wherever this is possible. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 & 17 were inspected at this inspection. People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will be able to take part in appropriate activities, some of which will be based in the local community. That they will be supported to maintain appropriate personal relationships with family and friends; and that their rights will be respected and their responsibilities recognised in helping them to construct an appropriate programme of activities in their daily lives. Residents were seen to be offered a healthy, nutritious and varied diet according to their needs. EVIDENCE: Standard 12 – The Manager told us that in order to ensure that each resident is involved in daily activities appropriate to their needs and wishes, staff Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 13 maintain daily activities sheets. These record the activities of each resident and link the activities with their care plan objectives and what they say they want to do. Inspection of the resident’s files showed that the resident’s care plan objectives do identify activities that are appropriate to the resident’s age and cultural needs. Residents interviewed said that they participate in the activities they wish to do. Residents told us that if they wanted to do an activity, staff would support them to do so. The Manager told us that as a part of trying to maintain continuity for the residents in their daily lives and to support their rehabilitation, where ever possible previous interests, pastimes, hobbies and relationship are encouraged and are built into the daily activities plan for residents. 2 residents who spoke to the Inspector said, “We do much more here than we did where we lived before”. As a part of the care plan review it became evident that significant relationship links for the residents are recorded in the care plans and that the importance for the residents of these links is not underestimated. Visitors are made welcome when they come to the home. Information about local activities was seen on the notice boards within the home and staff who were interviewed by the Inspector said how they will support residents, in their capacity as care support workers, to take as much of an active role in the community as is appropriate for residents. One member of staff at the time of the inspection talked to us about the importance for the residents to get out and about and socialise with other people. Another resident said that she had expressed a wish to attend church regularly in order to meet her faith needs. She is now supported by staff to attend church on a regular basis. Residents were seen to be supported and enabled to take part in appropriate activities and that they are able to express their wishes and be listened to and responded to with active and appropriate support. Standard 13 –Townley Road actively encourages residents to develop and maintain social, emotional and independent living skills where ever possible as a part of their rehabilitation package. Staff were seen to be actively supporting residents to make informed choices about the things they want to do and the activities they need to do. The central location of the home in East Dulwich makes access relatively easy for those residents who are able and want to use public transport. 2 residents said that they are looking forward to being able to make use of some of the local leisure facilities and the Manager told us that staff would support the residents to do so. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 14 The Manager informed us that all residents are registered to vote and are encouraged to use their votes. Residents confirmed that they are supported and enabled to vote. The Manager said that relations with the local neighbours are good with no problems arising up to this point in time for the home or for the neighbours. From information seen in the care plans and from discussions held with staff and residents, they do seem to be engaged as much as is possible with their local community and this will be likely to expand as their skills and abilities increase. The Manager said that some residents attend day centres outside of the home for a variety of reasons that all help to contribute to their well being and to their successful rehabilitation. This was also confirmed by the residents and by information put into the AQAA. Some of the other resources being used include volunteer training groups – covering areas such as computer training, food hygiene and learning other languages; snooker and the gym. Standard 15 – Interviews with 4 of the residents confirmed that where possible they do maintain regular contact with members of their families and either go out to visit their relatives or receive them at Townley Road. Residents said that they are enjoying the opportunities that they experience at Townley Road. Staff interviewed by us said that they encourage these visits and are sometimes involved in helping their resident’s sort out difficulties that they experience their relationships with their relatives as this often has a direct bearing on the mental well being of the resident. Visitors to the home are encouraged and use the visitor’s book to sign in. We saw information made available within the home about local activities for residents to take up if they wish. Standard 16 - Policies seen by the Inspector to be established within the unit ensure that service user’s rights to privacy, respect and dignity are respected. Those residents who were interviewed also confirmed that they felt staff respected these rights. Residents said that they have a key to their own bedrooms, that staff use their preferred form of address and that staff do knock on their doors before entering. We observed staff to be interacting with residents in a friendly and respectful manner and staff confirmed in interview that they understand how to respect the privacy and dignity needs of the residents. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 15 Interviews both with staff and residents confirmed that residents participate in household chores as a part of the rehabilitative process and this participation was supported in the residents care plans. Smokers are allowed to use the conservatory and there are appropriate policies regarding drug and alcohol taking on the premises. Standard 17 – Food menus shown to us indicate that menus are well balanced, nutritional and cater for the varying cultural and dietary needs of the residents. Menu choices are provided and the Manager told us that some residents assist in the drafting of the food menus. A rolling programme is used within the home. No complaints about the meals arose during the inspection in fact both those residents interviewed said that they like the food provided at Townley Road. It was noted that a wide range of meals were listed which cater for the multicultural needs and wishes of the residents. We asked the Manager if a dietician is used to advice on the menu planning in order to ensure that the food provided is always healthy and nutritious. The Manager said that a dietician attached to the Maudsley Hospital is used in some cases where there is a specific need and that training is also offered to staff and residents on menu planning. The Manager showed us a detailed food record that is kept for each resident and that is useful to help ensure that the service users maintain an appropriate diet that is healthy and nutritious. This was seen to be linked in with the residents care plan objectives and their weight records. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19, & 20 were inspected at this inspection. People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they will receive personal support in the way they prefer and require, they may also be assured that their physical and healthcare needs will be appropriately met. Service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Standard 18 – Residents who were interviewed at this inspection confirmed that they receive their care in the way they prefer. They said that they are able to decide themselves about their daily routines and this was backed up by care staff who were also interviewed by us. Staff ensure that care support at Townley Road is person led, flexible, consistent and is able to meet the changing needs of the residents. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 17 It was confirmed by the staff and the residents that they are able to choose when they get up, when they go to bed, when they have a bath, what they wear and what they will do during the day. A member of staff interviewed explained how when drawing up the weekly activities chart, which is based on the care plan, they always sit down with the resident and go through the programme in order to gain the residents approval and to understand their choices. Standard 19 - The Manager informed us that where possible the residents are encouraged to manage their own healthcare and appointments with healthcare professionals are generally at the local GP surgery but arrangements will be made if required for professionals to visit the home. The Manager told us that the residents are registered with dentists, opticians, chiropodists and community nurses in order to maintain their all round good health. Residents interviewed were able to confirm this. Information in their case files also evidences it by the recording of their contact with these services. Information seen in the resident’s casefiles confirmed that annual healthcare checks are routinely carried out by GPs. Standard 20 – The home’s policies and procedures manual contains appropriate policies for the control of medication. We reviewed the records for the administration of medication to residents (MAR sheets) and these were seen to be appropriately completed and in line with the home’s policies and procedures. Photographs of the residents were attached to the MAR sheets, which helps to ensure that staff administer medications to the right resident. We did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate and although controlled drugs are not currently in use within the home there is appropriate provision for doing so i.e. there is a lockable metal cupboard within a locked metal cabinet. There is also a refrigerated cupboard for those drugs requiring cool conditions. Lloyds the chemists provides training in medication; the Manager informed us that this is mandatory training for all staff. The staff interviewed said they had both received this training. At present residents are unable to administer their own medication. The home actively supports service users who wish to self medicate and appropriate facilities (e.g. lockable cabinets bolted to the walls) have been installed in each bedroom. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 were inspected at this inspection. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self-harm. EVIDENCE: Standard 22 – The 4 residents who spoke to us, all individually confirmed that they feel their views are listened to and acted upon. They said that if they had a complaint they know the procedure to be followed and would do so if they needed to. Staff interviewed confirmed with us that the residents were all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The homes’ complaints policy was inspected and the contact information for the CSCI is incorrect and needs to be amended. This is a recommendation. We asked the Manager to see the home’s complaints record. 2 complaints had been registered in the record book in 2007 and none in 2008. All had been resolved to the satisfaction of those people who had complained. The outcome of this practice is that the home learns from complaints in order to improve its service and all the residents know that their complaints and concerns will be listened to and dealt with appropriately. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 19 Standard 23 - The home has an adult protection policy that links directly into the L.B.Southwark’s adult protection policy. The Manager informed us that although all staff have undergone appropriate POVA training in previous years they have not had recent training experience. Inspection of the training information held in 4 of staff files inspected made it clear that only 1 member of staff had received this training in the last 3 years. It is therefore recommended that staff are enrolled for the next protection of vulnerable adults training course with L. B. Southwark over this year. It is thought as good practice that all staff should undertake POVA refresher training at least once every two years on an authorised training course preferably offered by L.B.Southwark. 3 members of staff interviewed confirmed that they know what to do if an allegation of abuse is made and they showed awareness of the procedures to be followed. This means that these staff are aware of what abuse is and the safeguards in place for the protection of the residents should they need them. Access to external agencies is actively promoted by the staff at Townley Road. We saw the allegation of abuse record; no allegations had been made since the last inspection. The Manager confirmed this. The policies and procedures manual for the home includes a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process and evidence of this was seen on file, staff are asked to sign to say that they have read and understood the policies and procedures for the home. The induction process also includes the TOPPS standards and this helps to improve staff’s understanding of occupational standards required in the home. The home does look after residents’ money and we reviewed the financial records of 4 residents for these transactions that all were in order. All transactions are dated and signed for by both staff and residents to confirm satisfaction by all parties. We found no anomalies. The Manager told us that Hexagon Housing carry out an audit of the financial procedures for residents annually and that no anomalies were found at the last audit. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 were inspected at this inspection. People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users at Townley Road are able to live in a homely, comfortable and safe environment. The home is also clean and hygienic and well looked after by staff. EVIDENCE: Standard 24 – A tour of the home together with the Manager was undertaken as a part of the inspection and the home was seen to be clean and tidy in all areas. Not all areas of the home are accessible to wheelchair users however at present none of the residents have the need to use a wheelchair. The general condition of the home and the facilities is good; communal areas and bedrooms are kept clean and odour-free. The staff do provide a ‘homely’ Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 21 touch through supplementary decoration and ornaments / flower decorations and pictures hanging on all the walls. The Manager has ensured that the physical environment of the home provides for the individual requirements of the residents. Also the communal living areas were found to be appropriate for the needs of the residents at the time of the inspection. Four of the residents said over the course of this inspection said that they see Townley Road as their home and that they find it a nice place and are happy living there. One resident said, “I like living here, I’m comfortable and feel supported”. Another resident said, “I like my room and the food is good. We’ve got a good cook”. A further comment made to the Inspector by another resident was, “Its my home for now, I like being here”. Townley Road is designed to provide small group living and people who live here can enjoy independence in a non-institutional environment. There is space within the home that may be used to entertain guests or for residents to sit quietly in. The Manager advised us that a handyman is employed for 20 hours per week to carry out routine maintenance around the home and that a log of repairs carried out is kept. This is generated from needs as they arise and these are written down by staff in a logbook that the handyman refers to. The Manager told us that an improvement plan for the home has been drawn up that identifies a list of agreed improvements, this information has come from staff and residents via the quality assurance audit that is referred to in more detail under Standard 39 later in this report. This means that residents do live in a safe and comfortable environment that they enjoy being in. Standard 30 – The Manager showed us the home’s infection control procedure, which seems comprehensive and to be effective in practice. At the time of this inspection the home was clean and hygienic. Staff interviewed confirmed that they are issued with appropriate clothing and equipment for them to carry out their work appropriately The laundry facilities in the home are appropriate for the 10 residents who are living in the home. We were informed by the Manager that laundry is not taken through any areas where food is being prepared. Written evidence in the form of a contract note was provided that confirms an appropriate clinical waste process is in place for dealing with clinical waste. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 & 36 were inspected at this inspection. People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users benefit from the clarity of staffing roles and responsibilities and they can be assured that they are supported by competent, appropriately trained, qualified and supervised staff. The homes recruitment policy and procedures helps protect the residents. EVIDENCE: Standard 32 – The Inspector saw staff working with residents at Townley Road to be approachable and to take time to deal with their questions appropriately and patiently. The Manager said that there is a training programme for staff provided both in house by staff and also external agency training. This covers all the essential training required by the staff to do their jobs well and efficiently. The provision of funding for training is also said to be good and the Manager told us that if a training need is identified then a training course could be provided. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 23 The Manager informed us that 7/9 of the support worker staff have achieved their NVQ level 3 awards and the other 2 are enrolled to undertake their NVQ level 3 awards, having gained their level 2 awards. All the other staff are Registered Mental Health Nurses. Some evidence of these qualifications was seen on the 4 staffing files inspected however it is recommended that evidence for all staff training and other qualifications is routinely held on staff files. The Inspector gained the impression over the course of this inspection that all the staff are committed to ensuring that their skills and knowledge is continually being developed by appropriate levels of training so that they can best meet the needs of the residents. Training records were examined by the Inspector and evidence was seen that evidenced staff had completing the following training courses: • 1st aid • Fire safety • Moving and handling • Food hygene • POVA • Health & safety • Infection control • Breakaway techniques • Conflict resolution • Women and mental health issues • Communication skills • Personality Disorder Standard 34 - The Manager told us that the home does have a recruitment policy and procedure and that all staffing posts are filled by application and interview. Evidence of these processes being used was seen by the Inspector on the staffing files. The Manager said that she, the Deputy and the Care and Support Manager usually constitute the interview panel. It was said by the Manager that there are plans for 2 residents to input the interview panel and process, this is to be welcomed so as to ensure residents views can be represented in this process. Review of 4 of the staffing files evidenced that suitable application forms are completed, that 2 references are obtained including one from the last employer. All staff files reviewed evidenced that proper CRB checks have been carried out for staff employed within this unit. The Manager told us that in all cases enhanced criminal record bureau (CRB) checks are carried out by the agency for all new staff. Documentary evidence was made available at this inspection. A new matrix for CRBs held for all staff on the staffing files was shown to us. This information certifies that the appropriate checks have been completed however in most cases these checks had been carried out in 2003 and 2004. It is good practice to renew all staff CRBs every 3 years. The Manager told us that CRB renewals for all staff has been planned for 2008 and Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 24 we were able to see that the matrix highlights the planned 2008 renewal dates. Documentary evidence was also seen that demonstrates CRB renewals are currently being carried out for the staff group. All other documentary evidence required (under Standard 34) for staff was seen to be held on the staff files reviewed. The result of this is that there is at Townley Road a staff team that has a balance of the skills, knowledge and experience to meet the needs of the residents. Staff interviewed confirmed that all have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home. Standard 35 – As already indicated earlier in this report the Manager has said that there is an overall training and development plan and budget for the home. The Manager said that a structured induction programme is offered to new staff and documentary evidence of this was seen and supported in interview with staff. It includes: • Safe working practices • The workers role • Meeting the needs of service users • The home’s policies and procedures. The Home’s management prioritise training and facilitate staff members to undertake training beyond the basic requirements. Internal training that is provided within the home by the Manager and other staff compliments the formal training offered to staff and enables the specific needs of the residents to be met in a person centred way. Training certificates were seen in most cases confirming that staff had attended the stated courses. However it is recommended that certificates are gained for all staff training and held on file. This is valuable for the staff member in that it provides documentary evidence of the training input they have received and helps to document their CVs. The Manager said that she has introduced a new staff training matrix that identifies future staff training needs and that logs training already undertaken by staff. This is a useful tool in that it will easily inform the Manager what training the staff team have received and where the gaps in training exist. The Manager explained that all staff who have undertaken training are asked to evaluate the experience they have had, how they have benefited from it and how they believe their work with residents may have of improved. A summary of the results of this evaluation were shown to us. This provides excellent feedback on the strengths and weaknesses of the training experience. Feedback to the trainers from the summary should help to ensure more Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 25 appropriately trained staff at Townley Road and better care delivered to the residents in meeting their needs. Standard 36 – The Manager told us that there is a properly structured staff supervision policy and procedure. Records were inspected and both the policy and the supervision tools comprehensively cover the areas that are required in order to implement an effective supervision process. Inspection of the supervision records that are held on staffing files showed that staff have received regular and formal supervision. Areas of discussion included: • Resident’s issues • The key working process • Monthly reports on progress made by key workers with care plans • Daily activities and outings for residents • Employment and training needs • Holidays and leave • Work performance issues. This means that all the key and important areas for the review and monitoring of the work being done in the home to meet the needs of both the residents and the staff groups should be properly met. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 & 42 were inspected at this inspection. People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users can be confident that they benefit from a well run home. The quality assurance system helps to ensure that their views underpin monitoring and review of the homes developments. Service users may also be confident that their rights and best interests are safeguarded by the home’s record keeping policies and procedures. EVIDENCE: Standard 37 – The Manager has 18 years experience of management experience at Townley Road. She holds her registered managers award at NVQ Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 27 level 4 and the Diploma in Management Studies. The Manager demonstrates a high level of competence in the management and running of Townley Road. The systems that are in place to ensure that the home is “fit for purpose” and meets the required standards are efficient and effective. This reflects very positively on the Manager and also on the staff team all of whom have developed and managed these processes well. The residents spoken to by us felt that the home is being well run and evidence seen supports this view. The homes records and administration systems were seen to be in very good order and overall the impression was extremely positive. Interviews with staff reflected a positive and caring approach towards the residents. Service users can therefore be assured that they are benefiting from a well run home. Standard 39 – The Manager explained the quality assurance processes being used within the home to ensure that resident’s views underpin all selfmonitoring review and development by the home. The Manager said that there is an annual management audit undertaken that reviews all health and safety issues, statutory and legal issues, the effective implementation of the homes policies and procedures, the environment and the building, staff and employment issues and training issues. A service user questionnaire is used to gain feedback from the residents and other questionnaires have also been devised to get feedback on issues to do with quality, from friends, families and visiting professionals. Quality checks are made on the recruitment procedures used to employ staff and a room-byroom risk assessment of the building is completed annually, information from which also informs the developments to be made in the home. We saw evidence of the feedback questionnaires and it was very positive in its detail. One respondent said, “Townley Road staff team are able to deliver a complex range of services and look after difficult clients very well.” Another said, “This is a very effective service 10 out of 10.” It is now recommended that the feedback gained from all these questionnaires be analysed and used to inform the annual development plan for this home. The plan could include the following information: • A review of all the key stakeholders feedback information including the Residents and service users, the Proprietor and the Directors, CSCI, Social Workers and Care Managers and the Care Staff. • Feedback from the manual audit of the room by room checks, • A review of issues raised at meetings for staff and residents, • A check on issues raised in the monthly progress reports for residents and their care plans. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 28 • Any themes arising from the complaints and accident/ incident reports. With the implementation of the quality assurance tool it means that there is in place a very effective method of maintaining high quality standards in the home. Standard 42 – We were shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. The Manager informed us that all staff receive training in moving and handling, fire safety, first aid, food hygiene, and infection control. This was supported by staff interviewed that confirmed that they had received training in these areas. Up to date certificates were seen for: Boiler & Gas – 21.6.07 – new test due Fire alarms – 14.4.08 Emergency lights – 14.4.08 Fire extinguishers – 14.4.08 Electrical system – 28.4.08 Portable electric appliances – 4.1.07 new test due Water tests – 10.4.08 Waste contract with PHS – 1.10.07 All food was seen to be stored appropriately and properly labelled with dates of opening and expiry. Records were seen that confirmed regular tests had been carried out for the: Fire alarm - weekly Fire extinguishers - weekly Emergency lighting – 6 monthly Fridge and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Accident records were checked – 2 records were noted to do with residents in 2008 and these were dealt with appropriately. Hot water temperatures were also checked and records indicated that they also came within the acceptable range. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. The Manager showed us a recently completed risk assessment for the building and another for the risk of fire. These are welcomed as it should assist in the prevention of accidents, raise awareness of the fire risks and what to do if a fire should arise and will inform the maintenance programme for the building. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 29 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 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 X 34 4 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 X 3 X X 4 X Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No. 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA22 YA23 YA35 YA39 Good Practice Recommendations The homes’ complaints policy was inspected and the contact information for the CSCI is incorrect and needs to be amended. That staff are enrolled for the next protection of vulnerable adults training course with L. B. Southwark over this year. That evidence for all staff training and other qualifications is routinely held on staff files. That the QA feedback gained from the questionnaires be analysed and used to inform the annual development plan for the home. Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Townley Road, 2-3 DS0000007000.V363087.R01.S.doc Version 5.2 Page 32 - 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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