Inspection on 21/02/06 for Herbert Street

This inspection was carried out on 21st February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Herbert Street 12/06/06

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 Pearlet Storrod Unannounced Inspection 21st February 2006 10:00 Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 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.V250755.R01.S.doc Version 5.1 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.V250755.R01.S.doc Version 5.1 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.V250755.R01.S.doc Version 5.1 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 5th August 2005 Date of last inspection Brief Description of the Service: Herbert Street is a registered care home where people with long-term misuse of alcohol are rehabilitated under a treatment regime set to assist individuals to maintain the goals that they set themselves relative to their sobriety. Herbert Street consists of two buildings one of which is a bungalow that can accommodate up to 4 wheelchair service users. It is situated at the back of the house, which accommodates 5 service users. Nine people are catered for between the ages of 18 to 65, three of whom can be over 65 years of age. Placement allocation is for maximum 6 months. The scheme is managed by Rugby House Project, a registered charity and is positioned in a good residential area in Kentish Town close to local shops and transports and other amenities. Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second inspection for Herbert Street for the year April 2005 – March 2006. This unannounced inspection focused on assessment of the requirements and recommendations made previously and discussion with the service users and staff, together with a tour of the houses, scrutiny of some of the documents and general observation. What the service does well: What has improved since the last inspection? What they could do better: Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 Page 6 The manager is imaginative in regard to the recruitment of volunteers for support at the home and there are approximately 4 volunteers attached to the service. Some consideration should be given to the ways in which volunteers are deployed; this point is made because the manager on the inspection day had difficulty locating some documents and the indexing of the policy and procedures file remained outstanding. As service users will be moving on to live more independently, the home could be more creative and give individual service users the choice to do some of the administrative tasks also. This would help to stimulate and develop the abilities of some individuals. In the past the practice of the responsible individual was to leave a copy of their monthly report in the home; there was no evidence of reports over the last few months. This is a regulatory requirement and its importance is for the inspector to ascertain from the monthly monitoring reports whether the provider is satisfied with overall management of the home. 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.V250755.R01.S.doc Version 5.1 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.V250755.R01.S.doc Version 5.1 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 and 5 Admissions are based on the assessment of service users’ needs and aspirations. Service users each have a statement of terms and conditions. EVIDENCE: The files of two service users were inspected and it is clear that assessments are robustly carried out. Information is available that informs potential and existing service users about the operational practices of the home. The service provides rehabilitation programme for a maximum of 6 months for people who misuse alcohol and the statement of terms and conditions include the timescale of service users’ placements. The nature of the service provision means that restrictions are used as support techniques for individuals who relapse. Service users understanding of the need for restrictions are necessary; individuals who relapse are required to sign a document entitled “relapse assignment” together with a “relapse support strategy” document. These agreements concur with the ethos and treatment of the service and the support that they provide and the aim is to prevent further potential risks of relapse. Service users are consulted about the agreements prior to giving their consents. Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 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): 6,8, and 10 Service users are involved in continuous assessment of their needs. They are consulted and supported to participate in all aspects of life in the home, either as individuals or within a group context. Service users are aware that information about them are handled appropriately and that their confidence is retained. EVIDENCE: There exists a continuous programme of periodic assessments during the 6 months stay at the home. Service users views are incorporated in the assessments and recorded care plans. One of the care plan examined showed that the home is providing support to individual with dual diagnosis of alcohol and associated mental health problems. This co-ordinated approach to care is working well. Individuals who relapse are obliged and supported to think about the reasons for their relapse and to consider the before and after effects of relapsing. The information is shared in a peer group. Compounded with this, the service user is also required to consent to a strategic support programme; necessitating the sharing of their feelings and emotions in a group; to give up their freedom to go outside the home without a companion from the community and to return the keys to the front door. Attending Alcoholics Anonymous and or Narcotics Anonymous are requirements outlined Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 Page 10 in the “relapse support strategy contract.” The method used is to illustrate the service user’s obligation and commitment to maintaining abstinence whilst at the home. The contract is for a period of four weeks following initial relapse. Confidentiality is within the group is a rule. Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 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 and 16 Staff have a good understanding of service users’ support needs and they are offered opportunities for personal development. Service users rights are generally respected and consultation relative to responsibilities for acceptance are agreed upon. EVIDENCE: Herbert Street offers is a short-stay resource that provides a service to people who generally might have had experiences of independent living and wishes to recover from alcohol misuse. On the day of the inspection service users set task was to draw up a set of goals with desirable outcomes for themselves. A volunteer from the local community arrived later and joined some group members who were experiencing difficulties in formulating their goals. A service user told the inspector that “one of his goals is for Camden to rehouse him to prevent him returning to live with his sister, where temptation to relapse would be available.” He said also, “I went into alcohol recovery because of the affect that alcohol was causing to my health, and it would be unwise for me return to live at my previous address. I am hoping that I am given a bed sit or a flat so that I could maintain my abstinence to alcohol.” This particular service user has other support needs and was in touch with RNIB for advice and support. Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 Page 12 Another service user has taken up an IT course at college. He talked about his progress to date and the possibility of getting paid work on completion of the course. One other service user due to move from Herbert Street within a few days received notification of accommodation and immediately went to view his proposed new home. Before leaving he told the inspector “he disliked being involved in the self assessment of goals”. Two other service users shared this view. The inspector discussed creative planning with the manager whereby individual service users could participate in some administrative tasks like indexing of the policy file, which is a recommendation outlined in the previous report. This would free up staff time enabling staff to deal with other duties. Other matters raised related to service users gauging themselves to take up voluntary or paid work. The manager said that “he could involve service users to assist in some administrative tasks, where confidentiality was not an issue and that the provider is considering expanding their resources to offering service users training for voluntary and paid employment.” It is evident from the positive relationships, which have been formed between paid staff, service users and volunteers, that the rights of service users are curtailed if relapse occurs. Such a restriction of service users’ rights in this regard are geared towards individuals accepting responsibility for their actions and is part of the ethos of the service provision. Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 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): 19 and 20 Service users are encouraged to lead as active a life as possible and individuals are supported to deal with their emotional health needs as appropriate. Service users are capable of managing their own medication that stored by the home for security purposes. EVIDENCE: During the inspection process the manager reported that a service user had been referred for bereavement counselling as recommended in the assessment report. Evidence is available to suggest that service users are supported to deal with their emotional health according to assessment of need. A service user with dual diagnosis of alcohol and mental health problems has been given a set time in which to overcome the problems relating to alcohol before admission to hospital for treatment associated with their mental health. The previous report made a requirement for improvement in the recording of medication administered to service users. This matter is satisfactorily addressed and medications received, stored, administered and disposed of are now appropriately logged. Service users self medicate at Herbert Street though medication prescribed for service users are stored securely in the home. Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 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 Service users feel confident that their views are listened to and where necessary, acted upon. EVIDENCE: There was one complaint logged in September 2005 from an external provider, which was followed up and dealt with to the satisfactory outcome of the complainant. Service users that were spoken to had no complaints. Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 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): 27 and 30 The toilets and bathrooms provide privacy and generally meet individual need with exception to a shower/wc room in the bungalow. Cleanliness within the communal areas of the house is unsatisfactory and kitchen cupboards and worktops are damaged and potentially hazardous to health. EVIDENCE: The service consists of a bungalow to the rear of the house to facilitate service users with disabilities. The shower in the bungalow was installed to accommodate a wheelchair but the doors fitted to the shower are inadequately installed, which poses difficulty for service users who use a wheelchair. For example, the turning point is insufficient to satisfactorily negotiate a wheelchair, making it impossible for wheelchair users to use the shower/wc room independently. A requirement is made for the doors to be removed as they also serve little or no purpose for wheelchair users to benefit from. This requirement is restated and must now be addressed. The worktops and kitchen units in both houses are now in poor condition with the bare wood visible in various places, which make the worktops no longer impervious. A requirement is made for a refurbishment of the kitchens. Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 Page 16 Notably during the tour of the house there was evidence to demonstrate that the stair carpet is worn in places and cleaning of the staircase had not taken place. These matters were outlined in the previous and are restated. It was pleasing to note that the tiles over a bath and in a shower room in the house had been attended to, making a more pleasant appearance. There are however evidence of the bathrooms left in a poor state of cleanliness and there are stains to the baths which could be removed to further enhance the improvement to the bathrooms. Efforts to remove the stains from the baths in the house should now be addressed and regular cleaning should occur. The manager explained that a rota was in place for service users to clean the bathrooms and staircase and that he intends to raise the issue at Friday’s group meeting. Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 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 Service users benefit from clarity of staff roles and responsibilities. EVIDENCE: On arrival to the home the inspector was greeted by the manager who confirmed that he was on duty by himself as a staff member resigned unexpectedly at the weekend; two other staff members were on holiday at the same time. He went on to say that “it was now Tuesday and not worth using agency cover at this time.” A service user mentioned, “His key worker had left the service and that he was unsure as to what support he would be given in resolving some of his outstanding issues that the keyworker was supporting him to deal with.” In discussion with the manager about this, he said, “he had told the individual that he himself would be supporting him.” There was no recorded information to suggest who the service user’s keyworker would be in the interim. Also, the manager’s time was taken up with the inspection and another visitor from the provider’s services. The manage is asked to review the home’s staffing level so that a minimum of two staff is on duty during the day, one of whom must be the registered manager, to meet service users assessed needs. The home has a number of volunteers who visit regularly to support service users. A volunteer visited the home during the inspection and from observation of the service users and discussion with a number of them; they were pleased with the volunteer’s assistance and support. Also, the volunteer being a Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 Page 18 female who works locally provided stimulation and emotional support to the female service user who said that “it was difficult being the only female service user amongst the men, the majority of whom are smokers.” Discussion with the volunteer demonstrated clearly that their roles and responsibilities as volunteers are known and understood and mutual respect was observed between the volunteer and service users. Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 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): 41, 42 and 43 The manager had difficulty locating the reports conducted by the responsible individual. These were said to be available and up to date but the up to date reports could not be found. Also, reference is made in the previous inspection report about the need for the policy file to be properly indexed. EVIDENCE: There were no up to date reports of regular monthly visits conducted by the responsible individual to demonstrate that quality monitoring takes place, although the manager said that these were available. A requirement is made that a copy of the monthly reports are left in the home each month for inspection. The manager had not carried out the recommendation to index the policy and procedures file as suggested in the previous report for ease of access. The inspector suggested to the manager to consider the way in which volunteers could be used at the home. Standard 42 is noted under Environmental Standards 24-30. Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 Page 20 Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 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 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 x ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 2 28 x 29 x 30 2 STAFFING Standard No Score 31 2 32 x 33 x 34 x 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x 3 x 3 LIFESTYLES Standard No Score 11 3 12 x 13 x 14 x 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 3 x x x x x 2 2 2 Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 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 YA27 Regulation Requirement Timescale for action 05/09/06 2 YA30 & YA42 YA31 3 4 YA43 13(4) The manager must ensure 23(1)(a)(2)(n) that the shower room in the bungalow is wheelchair accessable for service users independence without risk of injury. This requirement is restated 23(2)(b)(d) The manager must ensure that the kitchens are refurbished and that the house is clean and hygienic 18(1)(a) The manager must ensure that the staffing levels are at all times sufficient to meet service users’ assessed needs 26 The responsible individual must ensure that a copy of their monthly monitoring reports are left for inspection 05/04/06 05/04/06 05/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 Page 23 5 41 The manager should consider inserting an index to the policy file for ease of access. Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Herbert Street DS0000010348.V250755.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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