CARE HOME ADULTS 18-65
Mary & Joseph Palmerston Street Ancoats Manchester M12 6PT Lead Inspector
Steve OConnor Unannounced 31 August 2005
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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 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 Stationary 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. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 3 SERVICE INFORMATION
Name of service Mary & Joseph Address Palmerston Street Ancoats Manchester M12 6PT 0161 273 6881 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Joseph Cox Charity Responsible Individual - John Hubert Cox Bernard Cox Care home only 41 Category(ies) of Past or present alcohol dependence (A) registration, with number of places Mental disorder, excluding learning disability or dementia (MD) Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Service users must be male only. 2 All service users require care by reason of past or present alcohol dependence and may additionally require care by reason of mental disorder. The home is registered for a maximum of 41 services users. Staffing arrangements at the home must be maintained in line with the minimum levels set out in the guidance published by the Residential Forum `Care Staffing in Care Homes for Younger Adults. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 3 4 5 Date of last inspection 17 December 2004 Brief Description of the Service: Mary and Joseph House is a care home providing 24-hour residential care and accommodation for 41 men who are alcohol dependent and may also have mental health problems. The home is situated close to Manchester City Centre, near to local amenities and public transport links. The home was purpose built to meet the needs of the client group and is sited in a mixed residential and commercial area. Bedroom accommodation is provided over the ground and first floors. All bedrooms are single with hand washbasins and there are a number of selfcontained flats. The building is accessible for people who use wheelchairs and accommodation is based on the ground floor. Communal space is provided throughout the building and there is a large well maintained garden. There are also laundry and kitchen facilities based on the ground floor. On admission to the home, people are not expected to stop drinking alcohol, however, they are offered support to reduce or stop their alcohol use. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 31st August 2005. During the inspection time was spent talking with the people who lived at the home, with staff on duty and the registered manager. In addition people’s files, records and other relevant documentation were examined. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. At the previous inspection one area of the medication administration system needed to be improved. The home had taken the action and made the changes needed to meet the required standard. The Commission for Social Care Inspection (CSCI) had not received any complaints about the home since the last inspection. What the service does well:
The home supports men who, due to their alcohol use, require 24 hour supported accommodation. They have experienced a range of alcohol related problems that have seriously affected their general and emotional health, family and personal relationships, employment and finances. The home offers men the opportunity to be able to continue drinking alcohol if they wish, but in a safe environment. No restrictions are placed on alcohol or tobacco use unless agreed between the person and the home. Almost all the men have worked closely with the home to agree to manage their alcohol use in a different way. An example of how this agreement works was described by one man who described his life before coming to live at the home as chaotic and destructive and involved drinking several bottles of spirits daily. Since coming to live at the home the man has reduced his drinking down to several cans of beer a day and, in his own words, ‘ has found the real me again.’ This was just one of many examples where people have worked with the home and been supported and encouraged to reduce their alcohol use and so improve their health, wellbeing and personal life. The home places a great deal of importance on the standard of people’s environment and in providing a comfortable, well-maintained and clean place to live. The premises consist of a range of communal rooms and activity areas that are all clean, well maintained and decorated. The garden and external grounds provide a colourful and peaceful area for the men to relax or to become involved in its design and upkeep. Several people specifically
Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 6 mentioned the standard of their bedrooms and communal areas compared to where they had previously lived. The home places a lot of importance and resources on being able to offer people a choice of opportunities and activities and letting them decide what they would like to take part in. The home has a dedicated art workshop where people can work on individual and group projects. People spoken to who have produced artwork were clearly proud of their achievements with examples of their work decorating the home and being entered for exhibitions. The home also offers people opportunities to access local education services and one person has applied for a degree course with the Open University. The home works with the men in developing new ideas and suggestions for social, leisure and other activities and then provides the information, support or service needed. The home was commended for the positive action and opportunities they offer to people who could then make the decision as to whether they wanted to take up any of these activities. What has improved since the last inspection?
To be able to offer the support and help that a person needs and wants the home has to be able to understand the person, their background, the events that have affected their lives, their general and mental health and, most importantly, what the person wants to do and how they want to be supported. To do this the home has developed a way of finding out about the person and what support they need. This looks at all areas of their life and encourages people to work with a named keyworker to develop a Care Plan. This Care Plan sets out in a clear and detailed way what a person needs and what they would like to achieve in their lives. It gives lots of information about the things that are important to that person and describes how the home is going to support them. This means that not only are staff clear about how they should be working with people but it also gives the men greater control over their life at the home and not have things just done for them. The home also works closely with people to make sure that the support they provide is working and helping them to achieve what they want. This means that the home is trying to look at new and different ways of helping people and recognising when changes take place and reacting to those changes. The home have put a lot of thought and hard work into developing this care planning system and providing staff with the encouragement, guidance and training needed to make it work. This was highly commended. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 7 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. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 9 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 standard(s) 2 People’s needs were fully assessed prior to admission to the home. EVIDENCE: Purchasing authorities community care assessments were provided to the home prior to an admission. The home undertook an initial pre-admission assessment and when a person came to live at the home a further assessment of need was undertaken with the keyworker. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 The home had the policies, procedures and systems in place to identify people’s ongoing goals and needs and allow them to take risks within a supportive environment. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 11 EVIDENCE: The home had developed a care planning process that allowed for an in-depth description of people’s individual needs and made clear reference to the agreed goals and the support required to meet those goals. The responsibility for developing the Care Plan was with the person and their key worker that allowed the development of a relationship and also focused on what the person wanted to achieve. Additional training had been provided to help the staff to develop assessment and care planning skills. The care plan review process provided a detailed record of people’s goals, the support offered to meet those goals and a summary of the effectiveness of the support. Changes to the care plan were discussed with the person during the review had been clearly recorded. The care plan reviews recorded people’s views on the progress they felt they were making. The introduction of the new care planning and review process was an area of good practice and was commended. The Risk Assessment and Management Policy was seen and continued to contain a clear procedure for undertaking risk assessments. Issues of risk, especially in relation to service users alcohol use, were identified during the pre-admission process and on an ongoing basis through the care plan review process. A number of relevant risk assessments were seen covering environmental, behavioural and personal care issues. The assessments were thorough and gave clear details of how to support people to manage risks. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 14 The home provides the opportunities and support to allow people to chose to participate in a range of valued social, leisure, therapeutic and educational activities. EVIDENCE: The home has continued to provide and to develop new opportunities and activities for people to participate in if they wanted to. There were several examples of imaginative and person centred work using art therapies, fitness, education opportunities and community and in-house social and leisure activities. The home showed that they see this area of work as central to the support they provide and was an example of good practice that was commended. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 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 standard(s) 18, 19 and 20 The home provided the support and access to health services to maintain people’s person and healthcare. The medication administration system allowed for people to keep control of their own medication and provided the systems needed for those who required support. EVIDENCE: The home continues to maintain people’s personal care needs and goals and the support was clearly recorded in the Care Plans. Moving and Handling risk assessments had been completed for people who required hands-on support. Equipment and aids such as grab rails, a shower chair and hoist were available to support personal care needs and specialist input from health providers such as occupational therapists and physiotherapists was used in providing guidance and advice on equipment and support needs. Care plans contained detailed medical histories and of health needs gathered from current and previous health service input. People were supported to attend and access regular appointments with G.P’s, chiropodists, dentists, district nurses and community psychiatric nurses. The home worked closely with the community alcohol and mental health teams. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 14 The medication administration policies, procedures and systems met people’s health needs. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 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 standard(s) EVIDENCE: These standards were not assessed during this inspection. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 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 standard(s) 24 and 30 The home provides a well maintained, clean and safe environment for people to live. EVIDENCE: The home was in the process of a major refurbishment and redecoration programme to further enhance the standard of the premises and people’s environment. The premises continued to be clean, well maintained and the facilities and layout met people’s need. People had been involved in the decisions regarding the decoration of their rooms and the communal areas of the building. The home continued to provide a safe, clean and hygienic environment. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed during this assessment. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed during this inspection. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 19 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 x 3 x x x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 4 4 4 x x x Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Mary & Joseph Score 3 3 3 x
F55 F05 s21619 Mary Stage 4.doc Standard No 37 38 39 40 41 42 43 Score x x x x x x x Joseph V247173 D310805 Version 1.40 Page 20 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 Regulation Requirement No requirements were made as a result of this inspectionl. Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 6 Good Practice Recommendations It is recommended that the home ensure that the care planning and review system is clearly documented with procedures and guidance so that anyone can operate the system. Mary & Joseph F55 F05 s21619 Mary Stage 4.doc Joseph V247173 D310805 Version 1.40 Page 21 Commission for Social Care Inspection 9th Floor, Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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