Inspection on 12/06/06 for Herbert Street

This inspection was carried out on 12th June 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Herbert Street 21/02/06

Herbert Street 05/08/05

Herbert Street 14/10/04

Herbert Street 17/06/04

Herbert Street 10/03/04

Similar services:

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Haven (The)

Charis

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

CARE HOME ADULTS 18-65 Herbert Street 2 Herbert Street London NW5 4HD Lead Inspector Ms Edi O’Farrell Unannounced Inspection 12th June 2006 11:35 Herbert Street DS0000010348.V288060.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 Herbert Street DS0000010348.V288060.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. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Herbert Street Address 2 Herbert Street London NW5 4HD 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 7916 5013 0207 813 5960 Rugby House Project Mr Ralph Graham Weller Care Home 9 Category(ies) of Past or present alcohol dependence (9), Past or registration, with number present alcohol dependence over 65 years of of places age (3) Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service can admit up to 3 service users between the ages of 65 and 75, in keeping with the above service user categories 21/02/06 Date of last inspection Brief Description of the Service: Herbert Street scheme is a registered care home providing a structured treatment programme for people who have problem alcohol and/or drug misuse. It is part of the Rugby House organisation, which is a registered charity with its central offices based at 480A Holloway Road N7 6HT. There are nine residential places for people aged 18 to 65. The home is registered to have three of this number over the age of 65 if required. The scheme offers a highly structured dependency treatment programme and aims to enable residents to maintain and support abstinence. Placements are for a period of up to six months, and are dependent on funding from statutory drug and alcohol services. Herbert Street is in North London NW5 in a residential area minutes from Queens Crescent shopping facilities and a bus ride from Kentish Town and Camden Town. Parking is limited. The building is purpose built in two separate units, a house and a bungalow. There are five single bedrooms in the house and four in the bungalow. The house and bungalow are on the same site separated by an attractive courtyard garden. The communal facilities comprise two shared kitchen/dining rooms and sitting rooms, laundry facilities and courtyard gardens. There are three bathrooms and five toilets in the project. Residents pay £4.05 towards the cost of their placement, with the remaining £636.51 being paid by the placing authority and from benefits. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This, unannounced, visit took place on a weekday from late morning to early afternoon. The building was toured, and two residents and three staff members were asked about the running of the home. Records were examined, including the reports prepared by the external manager who visits the home on a monthly basis. The Commission uses the term ‘service user’ when writing about people who use social care services. At this service ‘resident’ is used so it has therefore been used in this report. Judgments about the quality of the service have been based on known best practice for this type of specialist service. Residents and staff are thanked for their input to the inspection. What the service does well: What has improved since the last inspection? The shower room in the bungalow has been altered so that it is accessible to people in wheelchairs. The current residents have carried out a ‘deep clean’ of the home, with the assistance of a contract cleaner. This makes the environment more pleasant for the people living in the home. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 6 There is now a weekly acupuncture session. Recent research into this type of therapy has demonstrated that it can be extremely helpful in supporting people who have used alcohol and/or drugs to a negative effect. 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. Herbert Street DS0000010348.V288060.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 Herbert Street DS0000010348.V288060.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Residents actively choose to move into the home, having detailed information about the treatment programme. Admissions are based on comprehensive assessment of need and aspirations. EVIDENCE: Residents stated that they had chosen to move into the home, and had full knowledge of the programme offered. Case files held detailed assessments, which included what each resident wished to achieve whilst staying in the home. As this is a structured programme, with a strict no alcohol or drug taking approach, residents have to sign a care contract. This includes any other agreed restrictions, such as non-contact with former friends. It also includes agreement to attend groups and keyword sessions. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 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): Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Residents are fully involved in continuous assessment of their needs. They identify personal goals and these are reflected in their care plans. They make decisions about their lives, within the context of their care contract. Risk taking is a central element of the structured programme. Service users know that information about them is handled appropriately, and that their confidences are kept. EVIDENCE: Two residents were asked their views and two case files examined. As stated previously in this report anyone moving in is making an active choice to enter the programme. They are fully involved in their assessment, which is on-going throughout the programme. They sign a care contract, which stipulates any restrictions to their lifestyle. They attend a variety of open and themed therapeutic groups, where the onus is on them to share information about themselves. Changes to their lifestyle, such as restrictions on going to certain areas, are agreed as part of the care contract. Where relapse occurs a relapse support strategy is put in place, and signed by the resident and a member of staff. The home uses a therapeutic community model where residents are fully involved in the running of the home. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 10 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, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Residents are supported to develop healthier lifestyles, which match their aspirations and wishes. Their rights and responsibilities are recognised within the context of their care contract. Residents are encouraged to eat healthily. EVIDENCE: Two care plans were examined, along with the weekly programme. Two residents were asked their views, and staff were observed debriefing following an open group meeting. Staff were also asked about the programme, and approaches used within the home. People moving into this home are making an active choice to change their lifestyles. Staff use a variety of approaches to assist them with this. This includes therapeutic groups, which are either open, or topic specific. Individual keywork sessions are held weekly, when progress towards identified goals is reviewed. The programme is structured into stages, with an initial inward focus. As people move through the programme the focus starts to shift. Towards the Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 11 end there is a focus on preparing to leave, and move into a different type of environment. As people move through the different stages they are continually encouraged to review their goals and objectives. This includes opportunities for personal development, appropriate activities and friends, and community involvement. The therapeutic community model encourages peer interaction and support. The care contract and relapse support strategies balance rights and responsibilities. Residents buy their own food and cook their own meals. Residents complete a daily progress report, and this includes a section on meals. Keywork sessions and groups are used to discuss the importance of a healthy diet, and the potential for substitution of types of food, e.g. chocolate, for alcohol or drugs. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Residents are supported to develop strategies to deal with their emotional needs. Where health needs are identified arrangements are made for these to be met. Residents are protected by the approach the home takes to medication. EVIDENCE: Two residents were asked their views and two case files were examined. Staff were observed interacting with residents, including discussing physical and emotional health needs. The assessments identify any physical health problems. These can be specific to alcohol and drug use, such as vitamin deficiency, or more general. During the visit a resident asked staff for medication for painful sinuses. Staff demonstrated knowledge of the contra-indication of certain drugs for people in recovery. The senior practitioner immediately contacted the GP and made an appointment so that appropriate medication could be obtained. Emotional health needs are also identified in the assessments, and the development of healthy strategies for coping are at the core of the recovery programme. There is an eclectic approach, which whilst structured, is also flexible to meet the individual needs of residents. Psychodynamic and cognitive approaches assist residents in understanding past behaviour. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 13 Therapeutic community methods develop peer relationships, helping to increase self-awareness and confidence. The home has also recently arranged for weekly acupuncture sessions, which has been demonstrated to be effective in these types of services. Written records and observation of staff discussion during the visit demonstrated that the service is well able to meet the health needs of the people who choose to live at the home. Most medication is kept in a secure cupboard in the office. Residents then ask for the medication at the appropriate time. Staff complete a medication administration chart at that stage. A record is kept of all medication received and returned to the chemist. Two charts and the content of the cupboard were checked and found to be in order. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users feel their views are listened to and acted upon. They are protected, as far as possible, from abuse, self-harm and neglect. EVIDENCE: The record of complaints was looked at, along with case records. Past complaints have been responded to appropriately. Concerns raised on a dayto-day basis, such as the quality of a mattress, or disagreement with a sanction decision, are responded to. The response to the latter is made within the context of the care contract, and may not always be made in the resident’s favour. However, during the visit staff demonstrated that they take such comments seriously. People who use alcohol and drugs can often place themselves in very vulnerable situations. Past abusive experiences are included in the assessments and care plans and contracts. Residents are encouraged to share experiences with their peers in groups, but their confidences are respected if they choose not to do so. Staff are aware of their responsibilities under No Secrets, but may face a dilemma if any potential abuse was suspected. This is because residents may not see themselves as ‘vulnerable adults’. Staff are competent enough to be able to balance rights and responsibilities should such a situation ever occur. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home meets the needs of the residents, but furnishings and fittings are basic. Residents, with the in-put of a contract cleaner, have worked hard to improve the level of cleanliness. EVIDENCE: The shower in the bungalow has been altered so that a person in a wheelchair could more easily access it. The kitchens have not yet been upgraded, and as pointed out in the last report, are unhygienic due to bare wood being visible in various places. This is Requirement 1 restated with a new timescale, which must be adhered to. The manager must inform the Commission when this work has been completed. The failure to meet this Requirement is not the fault of the service providers, but of the housing association, which has responsibility for maintenance. As stated in the last Regulation 26 report, ‘There is evidence of numerous emails to CHA regarding this matter, and copies of the last inspection report have been forwarded.’ However under CSA 2000 the service providers are responsible for the home meeting all Regulations. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 16 One resident reported that mattresses were of a poor quality, and the one seen had a stain on it. As this matter has already been identified in the last Regulation 26 report no Requirement has been set. Two of the bedrooms were visited and whilst functional the furniture is basic. This may be due to the transient nature of the resident, in that the maximum stay is six months, so it is not their ‘home’ as in ling-stay care homes. Previous reports have commented on the poor state of cleanliness. This is a difficult area because the home uses the therapeutic community model, where residents take responsibility for the home as part of the treatment regime. This means that standards might vary at times. On this visit the home was found to be clean, having been recently deep cleaned with the assistance of a contract cleaner. Some carpets were noted to be stained, but as this has already been noted in the last Regulation 26 report no Requirement has been set. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 17 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): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. Residents benefit from a staff team who are clear about their roles and responsibilities, and the ethos of the home. Staff are very competent, follow training appropriate to their jobs, and receive regular supervision. EVIDENCE: Three members of staff were on duty during the visit, with two being in an open group at the start. One member of staff started at the home the previous week having moved from another service run by the same organisation. She confirmed that the recruitment process had been very thorough, in line with equal opportunities, as she had gone through the same process as external candidates. Recruitment files are held at head office so were not examined as part of this inspection. However, there are no outstanding Requirements, so the evidence is that the Standard remains met. The new member of staff had her induction programme with her. This is excellent, being based on both the NMS and drug and alcohol worker competencies. New staff self-assess and a look at this worker’s assessment demonstrated a high level of self-awareness of knowledge and knowledge gaps. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 18 All three staff are currently studying at higher degree level, which they are funding themselves. The organisation gives a half-day study leave per week for this. The courses they are following are job related. Although it is a small staff team of seven the numbers meet the needs of the residents. Therapeutic work is the main focus of this service rather than personal care as in many home covered by the CSA 2000. Residents felt that staff were always there and helpful. Records showed that where residents wanted extra support, for example when they had relapsed and were distressed, that they received it. Staff are deployed so that the structured programme can take place. This means that it is usual for one person to be on duty from 4.00pm each afternoon. This member of staff then sleeps in. There is a back up emergency call out service if required, e.g. should a resident become too distressed to be supported by one member of staff. In practice, in this type of service, peer support from other residents would be the most usual response. There is an in-house training programme. Recent courses have included handling aggression, fire prevention, and first aid. The senior practitioner is nearing completion as a NVQ assessor, and two members of staff are doing NVQ3. Staff demonstrated a high level of knowledge of alcohol and drug use, and appropriate interventions. Case records showed that they apply this knowledge to their work, without stereotyping residents. They have the ability to use theoretical knowledge to the best advantage of each individual service user. This includes acknowledging diversity; there was an interesting discussion about the timing of groups during the world cup, and the possibility of changing times if they clashed with the England team matches. Staff immediately realised that any decision would also need to take account of all service users’ racial origins. Staff have individual supervision on a fortnightly basis, and weekly whilst on their six weeks induction programme. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 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, 38, 39, 42 & 43 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents benefit from a well run home, which has a clear ethos. Their views underpin developments. The health, safety and welfare of staff and residents are generally protected. However, the kitchens still needing to be refurbished compromise this. EVIDENCE: The registered manager was on leave the week of the visit, so was not directly observed. There was, however, ample evidence to support the above judgement. Some of this evidence can be found in previous sections of this report, such as, structured programme, excellent assessment and care planning, excellent staff team, and resident involvement in the running of the home. In addition there are weekly and monthly health and safety checks, and excellent monthly reports by the Responsible Individual. The latter are informative, and identify shortfalls and required action. In short they achieve what the CSA 2000 intends them to achieve. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 20 The manager is currently undertaking the Registered Managers Award. Once this is completed and the kitchens are refurbished a judgement of excellent in this outcome area could be expected. There is a community group each Friday at which residents discuss life in the home. Their views are listened to, and used to make improvements to the service. Health and safety records were sampled, and all were up to date. Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 21 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 4 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 4 32 4 33 4 34 3 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 4 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 X 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 3 3 3 X X 2 4 Herbert Street DS0000010348.V288060.R01.S.doc Version 5.2 Page 22 Yes. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 YA30 YA42 Regulation 23(2)(b) & (d) Requirement The registered persons must ensure that the kitchens are refurbished. Previous timescale of 05/04/06 not met. The manager must inform the Commission once this work is completed. Timescale for action 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA41 Good Practice Recommendations The registered person should consider having an index to the policies and procedures file to enable easy access to any named policy. 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