CARE HOME ADULTS 18-65
Charis 31 Mile End Road Mile End London E1 4TP Lead Inspector
Seka Graovac Unannounced Inspection 14th September 2005 10:45 Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Charis Address 31 Mile End Road Mile End London E1 4TP 020 7790 3040 020 7702 8251 charis@thmission.f9.co.uk 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) Tower Hamlets Mission Mr Andrew R. Bannell Care Home 8 Category(ies) of Past or present alcohol dependence (8), Past or registration, with number present drug dependence (8) of places Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th January 2005 Brief Description of the Service: Tower Hamlets Mission was established in 1870 by Frederick Charrington, heir to a brewer’s fortune. It was set up as a charity by the Charity Commission in 1938, following his death. Charis opened in 1988. The word “Charis” means “grace” in the ancient Greek language. The Registered Provider, Tower Hamlets Mission aims to enable people who suffer from alcohol and/or drug dependency to break the cycle of chronic addiction and rebuild purposeful, stable lives through the provision of high quality, comprehensive residential therapy and rehabilitation. Charis Primary Programme is registered with the Commission for Social Care Inspection for provision of care and support to up to eight males with chronic addiction problems associated with alcohol or/and drug dependency. The Programme is six months long. Charis aims to assist its service users: to maintain abstinence as the foundation for a new life in recovery, to develop a more positive mental and emotional way of life, to develop a positive spirituality, to address any outstanding practical matters that need attention and to develop recreational and social activities in recovery. The Programme uses the Twelve Steps framework embracing the spiritual as well as physical, emotional, mental and social dimensions of a person. Apart from the Primary Programme, Charis provides move on accommodation on site in The Charis Second Stage and The Charis Terrace. The premises are situated in the heart of London’s East End, in a quiet close set back from the Mile End Road. The surroundings are peaceful and contemporary. The central feature of a light well and a courtyard with a small fountain and pool give light, a sense of space and a feeling of peace to the building that houses the Primary Programme. There is a Chapel for prayer and meditation. There are good public transport links and other community facilities within walking distance. The staff team and the management are experienced, skilled and committed to the development of the service, service users and themselves. Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and lasted approximately 3 hours. The inspector saw the Project’s Registered Manager, the Deputy Manager, a Counsellor/Key-worker, a Care Assistant, an Administrator, a Cook and all five service users. The inspector individually interviewed four service users and a recently employed care staff in order to find out about their own experience of the service. The inspector also walked around the building and saw all communal areas and some bedrooms if the doors were left wide open. She also spent some time looking at the Project’s records and documentation, such as: service users’ files, medication records, house meetings’ minutes, health and safety related records, adult and child protection policies and procedures. What the service does well: What has improved since the last inspection?
No requirements had been made at the previous two inspections that were unannounced and announced. The project continued to provide a high standard of service in most aspects and also continued to improve. Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 6 The inspector was informed that since the previous inspection the Project’s protection policies were reviewed in line with the Local Authority’s ones. Two related training videos were viewed by staff. The management has been liaising with Tower Hamlets in respect of these procedures and also regarding recycling. Rules for visiting hours have been changed in response to service users’ request. The therapeutic programme notes were further developed. The inspector was also informed that a DVD-player was purchased for the communal use. And also there were more ornamental fish swimming in the pool. 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. Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Both the service users and the Project had comprehensive information about each other before the agreement regarding the service provision was signed by both parties. EVIDENCE: The project has an up-to date service users’ guide that provides comprehensive information about the service. Following an initial pre-admission assessment, further assessments of support and care needs were carried out during the first fortnight of living in the Charis. These covered the following: alcohol and substance misuse history, psychological, social, housing, legal, financial, nutritional, physical health, educational and other needs. This period is seen as “test driving” the service. Some service users spontaneously commented how beneficial that practice was for them. All of them confirmed that they were well aware of the content of the programme and the ground rules that came with it and were able to make informed choices before committing to the treatment. Two randomly chosen service users’ files contained the care and support needs assessments, rules and responsibilities, routines and other information as well as full contracts signed by both parties. Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, 8, 9 and 10. The service was delivered in accordance with the well documented individual care plans that had been agreed with both parties. EVIDENCE: The service users’ individual care plans were based on comprehensive care needs assessments. Apart from on-going evaluation, the inspector was informed that the individual plans were reviewed formally half way through the programme, after 3 months of being in the Project. Current care plans and individual risk assessments were available for inspection in the service users’ files. The service users’ satisfaction with the service provision was very high. In their individual conversations with the inspector they used the following words to describe their experience of the service: “I am really happy here”, “It’s a fabulous place”, “It’s spot on, it could not be better”, “I have learnt so much since being here”, “I am truly impressed by this place”, “I would recommend it to any addict. If you are suffering, come here and get better”… Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 10 House meetings that provided the opportunity for service users to share their views and feelings about the Project were held on a weekly basis. The inspector saw the minutes of these meetings. The service users told the inspector that their privacy and confidentiality were fully respected and that the staff were very professional. The service users expressed their full commitment towards the programme and reaching the outcomes as identified in their individual care plans. One service user in particular emphasised the positive effect that the staff encouragement of his independence had on him. Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. The service users’ lifestyles and the programme at the Charis facilitated recovery, encouraged self-awareness, personal integration, independence and spiritual exploration. The service users enjoyed their food, but the inspector required that the open packaging of perishable food must be dated. EVIDENCE: Charis is based on a structured programme that facilitates all areas of personal development. The Project holds daily group therapy meetings and recovery spiritual groups. Individual work includes “Life story”, “Stepwork” and counselling sessions with a Key-worker. Service users are also required to attend AA/NA (Alcoholics Anonymous, Narcotics Anonymous) meetings on a regular basis. The whole Project is focused on providing the best conditions for the service users to increase their awareness of underlying issues and selfunderstanding and fully engage in recovery. Breaking with the past and adoption of positive and constructive attitudes towards the self, others and society were main purposes of the Primary Programme. The service users expressed their satisfaction with the programme in their conversations with the inspector. The Deputy Manager told the inspector that
Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 12 some therapeutic records formats have been reviewed and further developed since the previous inspection. With their full consent, the service users’ involvement with the family, friends, work and “outside world” is limited in accordance with their programme and the primacy of their needs to recover from dependency. However, the inspector was also informed that the visiting time, as well as time for the outside activities have increased since the previous inspection on suggestion from the service users. Group outings were organised once a month in consultation with the service users. The inspector was informed that the most recent ones were visiting: Tower of London, Thorpe Park and Brighton. The service users told the inspector that they enjoyed food at the Charis. One service user told the inspector that he was particularly impressed with the implementation of health and safety rules in the kitchen. The menus were displayed in the dining room and the kitchen, showing variety of meals offered. The kitchen was well organised and clean at the time of the inspection. However, the inspector drew the cook’s attention to the fact that none of the opened packaging of perishable food that was appropriately stored in the fridges were dated when opened. The inspector was reassured that this food is readily consumed by service users and hasn’t been long since it was opened. The cook on her own initiative threw away opened items and replaced them with the new ones and agreed to date them in the future. Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 and 21. Although the project adopted an appropriate procedure for dealing with medication, at the inspection two shortfalls were identified. EVIDENCE: Apart from one particular medicine that had to be stored on low temperature, all other medication was appropriately kept locked in the cupboard in the office. The refrigerated medicine was kept in a closed plastic container with the service user’s name on it, but neither the container or the fridge were lockable. The fridge was in the lockable office and was used exclusively by staff. However, the management must ensure that all medication, without exception is kept securely locked. The inspector was also told that a box of Lemsip sachets that had been purchased over the counter on the day prior to the inspection still hasn’t been entered into the records. On examination of the medication and the records, the inspector found out that a box containing 32 Paracetamol tablets also hasn’t been entered. The project must ensure that correct records of all medicine are kept at all times. The inspector did not see any other discrepancies in records that contained both service users’ and staff signatures. One service user told the inspector
Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 14 how much he benefited from staff reminding him to take his medication, when he forgets. The examined service users’ files contained their wishes in case of sudden death. Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The service users benefited from the Project’s effective system for hearing and responding to issues raised and were protected and safe. EVIDENCE: The inspector was informed that no formal complaints or protection issues have been raised with the Project. No issues have been raised with the Commission for Social Care Inspection, either, since the previous inspection. The complaints procedure was clear and formed a part of the contract as seen on the service users’ individual files. The regular house meetings provided the opportunity for service users to make comments and raise any issues that might require attention. Some of the implemented changes were result of these meetings and proactive steps taken by the Project. The adult and child (as visiting the Project) protection procedures were dated April 2005 and linked to the Local Authority’s procedures. The inspector was informed that the Project was liaising with Tower Hamlets regarding their procedure. The inspector was also informed that the staff watched two training videos that focused on protection issues. Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28 and 30. The service users enjoyed well designed, well maintained and clean environment that included a Chapel, a patio and other gardens. EVIDENCE: The Charis is situated in the heart of London’s East End, in a quiet close set back from the Mile End Road. The surroundings are peaceful and contemporary. The central feature of a light well and a courtyard with a small fountain and pool give light, a sense of space and a feeling of peace to the building that houses the Primary Programme. There is a Chapel for prayer and meditation. There are good public transport links and other community facilities within walking distance. The premises were well maintained, tidy and clean at the time of the inspection. The service users commented positively about the environment in their conversations with the inspector. One service user was particularly pleased to have a Chapel on site. He said that he didn’t use it that often, but it helped him a lot knowing that it was there.
Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 17 The inspector was informed that a DVD-player was purchased for the communal use. And also there were more ornamental fish swimming in the pool. The Management was liaising with the Local Authority regarding recycling. Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 35. The service users’ individual and joint needs were met by a professional and effective staff team EVIDENCE: The service users were very complementary about the staff working at the Charis: “The staff are fantastic. It is not just work for them; they really care”, “The staff are so brilliant. It is like unconditional love”, “They helped me so much to be more aware of my feelings and face difficult issues”, “They are so sensitive to my needs”, “ I love that they gave me all the keys and support my independence…There is so much trust in between us and I completely surrendered to the treatment”…All service users mentioned to the inspector that they had used different similar type of services before, and that the Charis was “incomparably better then any of them”. The inspector’s conversations with the staff and the management, as well as examined records indicated that the staff were competent in their roles and delivered the service in a professional and effective way. Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. The service users benefited from a well run service. Their health, welfare and safety were protected and promoted. EVIDENCE: The service users’ satisfaction about the project was very high. There was a continuous process of reviews and consultation in place, together with the more formal individual reviews and weekly house meetings. The home was safe and well maintained at the time of the inspection. The health and safety risk assessments were in date and due for the annual review. Since the previous inspection, the manager arranged for further analysis of water samples to be done on a regular basis. Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 4 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 4 3 3 X 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Charis Score X X 2 3 Standard No 37 38 39 40 41 42 43 Score 3 X 3 X x 3 X DS0000010294.V250316.R01.S.doc Version 5.0 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement The Registered Person(s) must ensure that all medicine is appropriately recorded and kept securely locked. The Registered Person(s) must ensure that all opened packages of perishable food must be dated when opened. Timescale for action 30/09/05 2 YA17 16(2)(i) 18/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Charis DS0000010294.V250316.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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