Care Home: H.C.S. (Enfield) Ltd (Southbury Road)

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What the care home does well The home provides a good standard of care and support to a group of people with a range of complex needs, particularly older people with a learning disability who may have dementia. The people who live in the home were able to tell the inspector how much they enjoy living in the home or were observed to look happy and relaxed in their home environment. One person said, "we are very happy here". The home is supporting the residents to access healthcare professionals as required to meet their primary and more complex needs. The staff team are caring and demonstrate a good knowledge of the people who live in the home and were able to recognise their individual needs and how to respond appropriately to them. The key working system works effectively and residents know who their key worker is and it provides an appropriate system for ensuring each resident gets their individual needs met. The people who live in the home all feel able to express their views on the running of the home and are supported to make choices in their daily lives. The home whilst rather old is clean, comfortable and homely and the residents each have an attractive single bedroom. The home is also well located to provide easy access to the local supermarket and the town centre. What has improved since the last inspection? The last key inspection took place in June 2008 with a follow up inspection in November 2008. The requirements from these inspections have been completed. This has included ensuring the staff have received training on dementia so they can meet the needs of the residents. Each resident has been given a completed contract so it is clear what the home will provide and what residents need to pay for themselves. Each resident has a person centred care plan that is reviewed regularly. An annual review has taken place with each residents social worker. Monthly discussions are taking place with each persons key worker. A copy of staffs signatures are available so it is clear who has administered the medication. Each resident is being supported to monitor their weight. The managers and staff demonstrate a good understanding of safeguarding procedures and have referred matters appropriately to social services. There has been ongoing maintenance in the home. The views of the residents, relatives and other people involved with the home have been sought as part of a quality assurance exercise that aims to improve the service provided by the home. A fire safety emergency plan has been updated and put into place. All the equipment and installations used in the home have been serviced and maintained as needed. The receipts for items purchased by the residents are accessible so all expenditure can be accounted for where this is needed. The manager is keeping the records in an organised manner and old records have been archived to avoid confusion. What the care home could do better: A few requirements and recommendations have been made as a result of this inspection. The statement of purpose needs to be updated so that the information about the home is correct. Residents goals in their person centred plans need to be more specific and reflect actions agreed at their review meetings. The menu in the home has to be reviewed to ensure the food offered to the residents is healthy andnutritious at all times. Medication needs to be administered correctly to ensure residents take the correct medication. The house needs ongoing maintenance and bedrooms need to be fully equipped. Access to the call bell in the bedrooms needs to arranged for residents when they are sitting in their armchairs as well as when they are in bed. Staff supervisions need to take place more regularly. The fire alarm has to be checked each week to maintain fire safety in the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: H.C.S. (Enfield) Ltd (Southbury Road) 20-24 Southbury Road Enfield Middlesex EN1 1SA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Ray     Date: 0 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: H.C.S. (Enfield) Ltd (Southbury Road) 20-24 Southbury Road Enfield Middlesex EN1 1SA 02083646923 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : southburyroad2024@btconnect.com H.C.S.(Enfield) Ltd care home 12 Number of places (if applicable): Under 65 Over 65 1 learning disability Additional conditions: 11 Five specific service users who are currently resident in the home and are over 65 years of age may remain accommodated in the home. This condition must be reviewed at such times as any of the specified service users vacate the home. Date of last inspection Brief description of the care home Southbury Road is a care home managed by HCS (Enfield) Ltd and the registered provider is Mr Crausaz. The service is registered to provide 12 places to younger adults with a learning disability. The home was originally established to provide support to older people with a learning disability but over the years the service has been extended to younger adults with a learning disability and high physical care needs. The home consists of a group of terraced houses, which were combined into one dwelling. Each resident has a large single bedroom. The home has a lift to the first floor. The people with higher physical care needs have bedrooms on the ground floor. There is one assisted bathroom on the ground floor. There are two dining areas. People can either eat at a table in the large kitchen area or alternatively in a small separate Care Homes for Adults (18-65 years) Page 4 of 32 1 8 1 1 2 0 0 8 Brief description of the care home dining area, where a few of the more independent residents choose to eat. There are two lounges on the ground floor. Most of the residents also have a TV and a music system in their own rooms. There is a conservatory at the rear of the house, which acts as a sitting area and as a smoking area. There is a very pleasant garden with some sensory features. Staffing consists of a manager, senior carer and team of care staff working on a morning and afternoon shift. The night shift is covered by two waking night staff. The home also has a domestic and cook who work on weekdays. The weekly fees of the home range between 883.00 and 1380.00 pounds a week. The level of the fees depends on the support and services provided. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place on the 2 June 2009 and was unannounced. The inspection lasted for seven hours and was the key inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given eight of the ten current residents and spoke individually to three residents. The inspector was also able to spend time speaking to the manager. The inspector interviewed three of the care staff and spoke briefly to other members of the team. The inspector did a tour of the premises and also looked at a range of records including Care Homes for Adults (18-65 years) Page 6 of 32 resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self assessment questionnaire (AQAA) prior to the inspection. In addition the inspector received fifteen completed surveys from eight residents, five staff and two healthcare professionals. What the care home does well: What has improved since the last inspection? What they could do better: A few requirements and recommendations have been made as a result of this inspection. The statement of purpose needs to be updated so that the information about the home is correct. Residents goals in their person centred plans need to be more specific and reflect actions agreed at their review meetings. The menu in the home has to be reviewed to ensure the food offered to the residents is healthy and Care Homes for Adults (18-65 years) Page 8 of 32 nutritious at all times. Medication needs to be administered correctly to ensure residents take the correct medication. The house needs ongoing maintenance and bedrooms need to be fully equipped. Access to the call bell in the bedrooms needs to arranged for residents when they are sitting in their armchairs as well as when they are in bed. Staff supervisions need to take place more regularly. The fire alarm has to be checked each week to maintain fire safety in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be assured that their individual needs will be assessed and that the staff have the skills and ability to meet these needs. New people moving to the service will be supported to settle into the home. Some information provided by the home to people interested in living in the service is not completely up to date. Evidence: We provide a specialized service to our client group. All service users have a comprehensive needs assessment carried out before entering the home. All residents have received a contract which is in an easy to understand format and reviewed regularly. Anyone considering moving to the home is able to make visits to the home. (Extract from the AQAA prepared by the home) We looked at the statement of purpose and whilst it was clear and easy to understand some of the details were now out of date such as the name and experience of the current manager and the staffing structure. The statement of purpose needs to be amended so it is accurate and contains all the necessary information. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: One person has moved into the home since the last inspection. This person had come to the home as an emergency, but had been assessed by the home and comprehensive information had been provided by the care manager and the previous placement. This person had not been able to make any visits to the home as part of the moving in process, but staff from the previous home had visited to assist with settling her in and provide the staff with guidance on how to best meet her needs. The residents living in the home were also introduced appropriately to the new resident and one person said, when the new person arrived they brought her to my room to introduce her to me. We discussed the current needs of the people who live in the home with the care staff and inspected the staff training records. This indicated that the residents have a number of very specific individual needs including dementia and mental health issues. From talking to the manager and looking at training records it was seen that dementia training was taking place the day after the inspection to ensure all staff had completed this training. The resident who has moved most recently to the home uses makaton sign language and the manager explained that if she stays at the home the staff will all have this training updated. The contracts between the home and the resident were inspected for four residents. All these contracts were in a user friendly format and indicated what the home would provide for the resident as part of their fee. The contracts had all been appropriately signed. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home can be confident that they will be supported to make choices in their daily lives. Each person has a person centred care plan that reflects their individual wishes. Residents have a close relationship with their key workers and this ensures their care plans are implemented. Evidence: Monthly person centred planning reviews are carried out with the service users. Each service user has a key worker, the offer of advocacy, one to one meetings between the staff and service users, talking to and involving the service user with all aspects of their daily lives and offering choices. (Extract from the AQAA prepared by the home) My care plan, yes I have seen that. (Quote from a resident) We inspected care plans for four people currently living in the home. We also spoke to the staff about the care plans. All four of the people whose records were inspected had Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: a person centred care plan in place. These were clearly laid out and covered all aspects of each persons needs in an accessible format. Residents knew about their care plan and had copies available in their rooms. Some residents could sign their care plans but had not done so. All the care plans had been reviewed in the last six months and had been updated to reflect peoples changing needs. Each person has a record prepared each month by their key worker explaining what had taken place over that time. Each persons care plan included goals but these were rather general. For example one person had a goal to be stimulated with different activities. The people living in the home had all been supported to have a review meeting with their social worker and relatives in the last year and records of these meetings were available including some specific goals. Each persons goals need to be checked to ensure they are specific and achievable and reflect goals agreed at their review meetings. We spoke to three of the people living in the home about their key workers and they knew who they were and said they had a good relationship with them. One resident said, my key worker is very nice and today we are going shopping. The staff were asked about their key working role and were able to describe the support they gave especially with shopping and healthcare appointments. It was evident from discussions with residents that their relationship with their key worker was very important. The staff also demonstrated a good knowledge of the care plans and were able to describe how they help to keep them reviewed on an ongoing basis. We read the risk assessments for the same four people who live in the home. It was possible to see that an effort had been made to identify areas of personal risk and look at how this can be managed without placing unnecessary restrictions on people. Some of the residents needs had changed and these were not always reflected in the risk assessments. For example one resident was finding it harder to walk following a fall. The care plan had been amended to reflect these changes but there were new risk management issues that had not been included. We observed the people living in the home and their interaction with the staff. The staff were observed to be very aware of both verbal and non verbal communication. They responded quickly when they felt that residents wanted something or were uncomfortable in any way. One resident who chooses to spend more time in her room said, the staff check on me regularly. The manager explained that because the residents have very different individual needs, they have decided to discuss with each person on a monthly basis, what they would like to see happening in the home. The records of these discussions were seen and were an effective way of seeking the views of the residents. Care Homes for Adults (18-65 years) Page 14 of 32 Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to develop their daily living skills and are also enabled to follow their own routine. The home has made progress in supporting the residents to enjoy a good range of activities during the day and to enjoy accessing the local community. Evidence: The food is not too bad, they will make you something else if you want. (Quote from a resident) I buy my clothes when I go shopping in the town. (Quote from a resident) We spoke to the people living in the home and the staff about the activities. The AQAA also explained that out of the ten people currently living in the home, one goes to a Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: day service five days a week, one person goes to a day service two days a week and one person goes one day a week. One person is funded to have one hour of individual staffing a day. The residents were able to tell me that they were going out as much as they wanted and said this included going shopping, eating in restaurants and visiting the cinema or theatre. The staff also talked about new activities that have been introduced including the use of trampoline facilities at a local sports centre. There are also plans to introduce a multi sensory session for one resident. One resident did comment that she would like to go to the pub and bingo, which she has not done for a while. The staff explained how they try to support the residents to do as much as possible for themselves. The AQAA and the staff both explained that where possible residents are encouraged to hold their own money when they go out. The manager explained that rather then arranging holidays they are aiming to provide more days out for the residents. These have included trips to Paradise Park, Lakeside, Bluewater and Southend. We were able to observe during the inspection that the people living in the home were able to follow a routine of their choice. One resident said I go to bed when I want, usually at 10pm but earlier if I want to. In the morning it was seen that people were getting up later if they wanted to do so. The AQAA identified that the residents are mainly Christian and one person is Muslim. Most of the residents choose not to visit a place of worship and one person celebrates religious festivals with their family. One resident said she used to go to church regularly and would like to go again. The manager explained that three of the people living in the home have regular visits from their relatives and two others keep in touch with relatives by letter. One person has a befriender who keeps in touch by letter. Two of the residents have a very close friendship with each other and choose to sit together. We saw the four week menu and spoke to the staff members who were preparing the food. The residents were happy with the food and said they could always have an alternative if they preferred. The menu appeared to include a lot of red meat and processed food such as burgers, sausages and coated fish. It is suggested that the menu is reviewed, possibly with the help of a dietician to ensure it provides meals that are healthy and nutritious. Care Homes for Adults (18-65 years) Page 17 of 32 Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs. Medication systems are in place in the home, but not always used correctly. Evidence: Each person has a designated key worker and can change them if they want, their privacy and dignity is respected, there is a good staff ratio and flexible times for getting up or going to bed (Extract from the AQAA prepared by the home. We observed during the inspection that the staff were supporting the people living in the home to receive personal care in a manner that preserved their privacy and dignity. It was also observed that the staff communicated with the residents in an appropriate manner, sitting down with them and making good eye contact. There was a friendly and warm relationship between the residents and the staff team. The residents were observed to be wearing nice clothes and to have had haircuts. The Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: staff explained that a hairdresser visits the home each month. Some of them were able to talk about how they had been out shopping. We looked at the healthcare records for four of the people living in the home. They had all been supported to access a range of healthcare professionals including the GP, dentist, optician, district nurse, chiropodist and other outpatient appointments according to their individual needs. At the last inspection it was recommended that residents were weighed each month, especially if this is a matter of concern. The manager explained that where residents cannot use the weighing scales in the home, they are taken to a community clinic where there are scales available for people who cannot stand independently. We looked at the medication, administration records and staff training records. The home uses a blister pack medication administration system. The medication is stored in a locked cupboard in the office and the temperature of the cupboard is checked twice daily. The medication received in the home is recorded on the administration record as well as the medication returned to the pharmacy and this ensures there is an audit trail for each medication available. The administration records were correctly completed. The training records show that medication training is up to date for most of the staff and only staff who have completed the training are administering the medication. There is a record of the staff signatures for the staff who administer the medication. The only medication that is given as required is pain relief and this is given at the request of the resident. No controlled drugs were used at the time of the inspection. One resident had been prescribed a short dose of medication and the medication record showed it had not been administered the evening before the inspection. When the actual medication was checked, the final tablet had not been administered. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home have access to an appropriate complaints procedure and are protected by staff having received up to date training on safeguarding vulnerable adults. Residents are safeguarded by having appropriate systems in place to support them to manage their personal monies. Evidence: We have a complaints procedure in an easy to understand format, we have put complaints as an agenda item for our service users meetings as well as whistle blowing and the safeguarding adults protocol. (Extract from the AQAA prepared by the home) If I had a problem I would speak to any of the staff. (Quote from a resident) The AQAA stated that there had been three complaints in the last year. We looked at the complaints record and it was positive to see that complaints being made by residents were being addressed appropriately. There has been one safeguarding issue since the last inspection. This had been alerted appropriately by the home to social services and the home had contributed to the safeguarding meeting. This shows that the home understands how to respond appropriately to safeguarding issues. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: We looked at the staff training records and these show that most of the staff had either received safeguarding vulnerable adult training or had this training booked. We spoke to the care staff about the safeguarding adults procedure and they all displayed a good knowledge of how to recognise abuse and the importance to speaking to the manager about issues that arise. We checked the personal finances for three residents including their building society books, cash record, cash and receipts. Some of the residents have the local authority as their appointee and some residents are supported by a company appointee. All the residents have a building society account. The manager is responsible for supporting the residents to manage their personal monies and is the only person in the home with access to the building society books. In the home there is an individual finance record for each person and their cash is held in a lockable filing cabinet. All expenditure is recorded and receipts are available. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can know that they are living in an environment that is clean and comfortable. Ongoing maintenance is required as parts of the home are in need of work. Evidence: In the last twelve months we have changed the carpet in one service users bedroom. The small lounge and kitchen have been painted. We have bought new garden furniture and a kitchen table. We have also bought a table for the main lounge to do activities. (Extract from the AQAA prepared by the home) We did a tour of the home with the manager. The building consists of three terraced houses that have been joined together. The building is located on a main road within easy reach of Enfield Town and local shops. The building is on two levels and a lift is available. The layout of the building means that there is a long corridor particularly on the upper floor. Each person living in the home has an individual bedroom. Most of these have been redecorated. The bedrooms are comfortable and individually personalized. One resident who had recently changed bedrooms had chosen the colour of the paint for Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: her newly decorated room. It was however seen that she did not have a light shade and there was no aerial point for her television. Toilets and bathrooms are found throughout the house, but the disabled accessible bathroom on the ground floor is the bath used by most of the people living in the house. The AQAA said that they are aiming to obtain advice from an occupational therapist to develop bathing facilities upstairs that are accessible for the residents. The home has a large kitchen and dining area. There is a large and a small lounge. We observed that the home was clean throughout. The utility room had a washing machine and tumble drier and these were both working. The office is located on the ground floor and has internet access. It was observed that whilst some decoration has taken place parts of the house appear worn and in need of minor repairs or redecoration. This includes the external decoration. It was also observed for a couple of the residents that their reducing mobility makes it hard for them to reach the call bell in their rooms once they are out of bed and sitting in an armchair. This needs to be addressed so they can call for assistance as needed. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A team of staff consistently provide enough staff to meet the needs of the residents. The staff are receiving relevant ongoing training and are supported by regular team meetings. This enables them to work to a high standard and deliver good care. Evidence: We have a low staff turnover, ongoing training programme and the majority of staff have an NVQ level 2 or above. (Extract from the AQAA prepared by the home) I feel the home is getting better and better. (Quote from a member of staff) The rota showed that there are 16 staff working at Southbury Road of which there is one manager, one senior carer, 12 care staff, 1 cook and 1 cleaner / carer. Three new staff have joined the team in the last six months. The staffing levels are between three and five care staff on the day shifts and two waking night staff. It is positive to see that the staffing levels are flexible to reflect the needs of the residents and the activities that are taking place. The AQAA completed by the home stated that fourteen staff have either completed or our studying towards an NVQ in care at level 2 or 3. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: We looked at the recruitment records for three staff members who had started working in the service since the last inspection. All the recruitment checks were in place apart from one member of staff who was working with supervision as her POVA check was in place but she was waiting for her CRB. One member of staff did not have a copy of a photo ID and the manager explained that the passport was currently being held by the home office as part of a visa application. The three staff had all completed a comprehensive induction and had a chance to shadow existing staff before working on their own in the home. We inspected the training records. The home has a training matrix and this was up to date and so it was possible to accurately tell who had received training and when this had taken place. An ongoing training programme is in place including all the mandatory training. We spoke to the staff who were able to describe their ongoing training and said they found this very useful. We looked at the supervision records for the staff team. This showed that whilst all staff had received individual supervision this was not taking place every two months. The manager explained that the senior carer has received supervision skills training and is now observing supervisions before taking on this role. Once the senior can carry out supervisions this will enable them to take place regularly. The staff team meetings are taking placing regularly and from looking at the records these are very comprehensive. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a manager who is completing the registration process. She is working hard to improve the quality of the service provided for each of the residents. Health and safety systems are in place, although fire checks have not always taken place regularly. The service seeks the views of residents and other people who play a role in their lives as a way of improving the home. Evidence: We ensure service user needs are met, create a safe environment, are motivated and committed, listen to the service users and comply with company policies and procedures. (Extract from the AQAA prepared by the home) The manager is trying hard to improve the home, for example the residents are going out much more and enjoying the trips. (Quote from a member of staff) The manager explained that she has applied to be registered. She has completed the Registered Managers Award and has almost completed the NVQ level 4 in management Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: and care. The Regulation 26 visits to the home had taken place regularly and the reports were inspected. The details of the quality assurance exercise completed in March 2009 were inspected. This had sought the views of residents, relatives and other care professionals. The results had been collated into an action plan and this was being implemented. In terms of fire safety we had previously looked at the fire safety risk assessment and emergency plan and these were complete. The fire alarm and fire extinguishers had been serviced. The fire alarm records show the alarm is checked weekly apart from a period from March to April this year where checks were further apart. The manager explained that this was because the member of staff who does this job was not working and this matter had now been addressed. Fire drills are taking place about every two months and staff were able to explain what they would do in the event of a fire. The training records show that fire safety training has taken place for the whole staff team. The records in the home show that all the health and safety maintenance checks have taken place apart from the portable electrical appliances where the service was booked. The staff training records show that the staff have either completed or are booked to attend most of the health and safety training including food hygiene, moving and handling, first aid and infection control. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 6 The registered person must update the statement of purpose. This is to ensure the document is accurate and includes all the necessary information. 31/07/2009 2 17 16 The registered person must 17/07/2009 review the menu used in the home. This is to ensure the food is healthy and nutritious. 3 20 13 The registered person must ensure all medication is administered as prescribed. This is to ensure residents receive the correct medication. 17/07/2009 4 41 23 The registered person must ensure the fire alarm is checked weekly at all times. This is to maintain fire safety in the home. 30/06/2009 Care Homes for Adults (18-65 years) Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The registered person should ensure the goals in the person centred plan are clear and specific and reflect the goals agreed at the residents review meeting. The registered person should ensure risk assessments are reviewed when the needs of a resident change. The registered person should ensure that all the residents are offered the opportunity to go to a place of worship if they wish to do so. The registered person should ensure the home continues to have an ongoing decoration and maintenance programme. The registered person should ensure all the bedrooms have the necessary light shades and working television aerial points. The registered person should ensure residents have the equipment to call for staff assistance from all areas of their bedroom. The registered person should ensure supervision takes place regularly for all staff. 2 3 9 11 4 5 24 26 6 29 7 36 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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