Inspection on 30/11/05 for Mount Carmel

This inspection was carried out on 30th November 2005.

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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mount Carmel 02/01/09

Mount Carmel 03/01/07

Mount Carmel 10/05/05

Mount Carmel 21/02/05

Mount Carmel 28/04/04

Similar services:

Rugby House Project

City Roads Crisis Intervention

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Herbert Street

Haven (The)

Charis

Hartley House

Brook Drive, 124

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

CARE HOME ADULTS 18-65 Mount Carmel 12 Aldrington Road London SW16 1TH Lead Inspector Louise Phillips Unannounced Inspection 30th November 2005 10:00 Mount Carmel DS0000010212.V269399.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 Mount Carmel DS0000010212.V269399.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. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Mount Carmel Address 12 Aldrington Road London SW16 1TH 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 8769 7674 020 86960412 mountcarmeluk@yahoo.co.uk Mount Carmel Hostel for Recovering Alcoholics Limited Ms Ruth Elizabeth Allonby Care Home 18 Category(ies) of Past or present alcohol dependence (18), Past or registration, with number present alcohol dependence over 65 years of of places age (3), Past or present drug dependence (18), Past or present drug dependence over 65 years of age (3) Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may from time to time, admit up to 3 named persons over the age of 65 for short term rehabilitation. 10th May 2005 Date of last inspection Brief Description of the Service: Mount Carmel is a care home for clients who are recovering from alcohol addiction. The home provides treatment and therapy to clients who have followed a period of total abstinence. The stay at Mount Carmel is for approximately six months. During this time clients are supported to begin a Twelve Step programme of recovery from their addiction. The home focuses on the first five steps of the programme with support through group therapy and one-to-one counselling. The home is a four storey building and accommodates up to 18 men or women who each have their own bedroom. On the ground floor there is a kitchen, large communal dining area, two lounges, two counselling rooms and a small kitchenette for use by clients. There is a large parking area to the front of the property and a well-maintained garden to the rear of the home. The home is situated close to local shops and public transport links. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day with time spent talking to the manager and viewing paperwork. A tour of the premises took place and care records were inspected. Six of the staff on duty and three clients were spoken to during the inspection. What the service does well: What has improved since the last inspection? 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. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 6 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 Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 7 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, 4 and 5 Information at the home provides relevant details about the service aims and treatment offered to clients. The process of people moving into the home is structured and fully involving of the client. EVIDENCE: The manager described process of admission to the home. Initially clients refer themselves, or this is done through their social worker. Once the home receives this information they are sent a brochure that details the aims, objectives and treatment programme offered by Mount Carmel. The client completes an application form where they detail their drinking and any drug history, any physical problems, information about their family and the reasons why they would like to be at Mount Carmel. They are then invited to attend the home where they meet with a member of staff who will go through the assessment form with them. At this time the client will also be informed of the house rules, timetable of treatment programme and they will also be assessed for whether they are able to manage walking up the stairs. The client will receive a tour of the building by a person currently receiving treatment, where they are able to ask more questions about their experience of the programme. Once they move to the home they are provided with a copy of the ‘Residents Information Booklet’ (Service Users Guide) and a copy of the Licence Agreement which they sign. All clients are required to sign a contract to state that they have read and will abide by the rules as detailed in the booklet. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 8 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): 7, 8 and 9 The treatment provided by the home places limitations on human rights, yet these are made only in the person’s best interest and are consistent with the purpose of the service. The risk assessments would be much improved by ensuring that a plan is in place to manage any risks identified. EVIDENCE: Mount Carmel has very clear service provision, and the ‘Residents Information Booklet’ details the specific expectations of clients who are offered a place at the home. The aims of the home are to encourage clients to look at their self, their behaviours and their reasons for their drinking. Clients are encouraged to do this through the treatment programme, eg. group settings and one-to-one sessions with their counsellor. The booklet provided to client’s details their responsibility for confronting their peers to challenge their thoughts and behaviours. For a client undertaking this programme for the first time, this form of treatment can be uncomfortable because of what they are expected to do, and Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 9 from the feedback they receive from staff and peers about their behaviours. It can take some time for individual clients to open up and feel able to participate in the group work. One client stated that they do not feel that they handle confrontation well, and that being confronted by their peers and staff sometimes makes them feel that they are being ‘picked on’. One client also stated that they felt their human rights were being ignored. As stated earlier, the home has very clear expectations of the clients who use the service. On occasions where the staff feel that the programme is not being effective in addressing an individuals behaviour and there have been a number of incidents where they have breached house rules, the staff will implement a ‘treatment contract’. The contract is used where the behaviour is as such that a breach of the rules is not so serious as to require the individual to leave. The contract is drawn up with the client and is specific to addressing particular areas that the client needs to work upon whilst at the home, eg. not to use threatening or abusive language. The manager stated that any client on a contract has to read this out twice a week, at the House Meeting and Monday morning meeting, where they state what action they have taken, or are taking to address each point of the contract. The manager stated that at this time the contract is reviewed and that, depending on the actions being taken by the client, this can be withdrawn. She further stated that if a client wishes to appeal against their contract they need to raise this with their social worker. The use of a contract places limitations on people’s human rights and information about the process of review and appeal must be made available to the clients. Currently, this is not detailed on the contract or in any other written information provided to clients, and it is required that the Service Users Guide (Residents Information Booklet) includes details of this. It is also recommended that this information is provided on the contract and in the Service Manual. The previous inspection required that an assessment of any areas where there was considered to be any risk to the client was documented, with a plan put in place to manage this. It was observed that there are no risk management plans in place following the initial risk assessment carried out on the client. This requirement is restated. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 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): 17 Good developments have been made to ensure that all food provided at the home is safely stored and prepared. EVIDENCE: The previous inspection required that all people involved in preparing food at the home receive training in basic food hygiene. A staff member explained that this training is provided to all clients, and is introduced around the mid-way point of their six month treatment programme. All clients go through this training that consists of working through a handbook, sending these off to be assessed and also taking an exam. Successful clients are then presented with a certificate at a specially planned ceremony at the home. Two staff are trained in basic food hygiene to provide directions and advice to those undertaking their training, and also those exclients who return to the service to help prepare the meals. The ex-client cooking on the day was spoken to briefly, where they stated they enjoyed doing the course. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 11 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 The home has made good improvements to the medication system to promote appropriate storage and record-keeping. Further work is needed on the process of clients seeing their GP to ensure that their rights are respected. EVIDENCE: On the 9th June 2005 an inspection was carried out by the CSCI pharmacy inspector and the requirements made were followed up on this occasion. The home has worked well to address all the requirements made, with risk assessments in place to cover the storage of medication by clients in their room and also for the safe storage of any oxygen in use at the home. The medication records also demonstrate that the non-supplying of medication to clients is appropriately documented, and also where a client refuses or wishes to stop taking their medication. A recommendation was also addressed, with the implementation of a book to record the disposal and return of medication to the chemist. Support with physical health is provided by the local GP who all clients register with when they move to the home. One client stated that they felt their going to see the GP was disapproved of by the manager of the home. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 12 The manager stated that the monitoring of each client’s mental health is part of the work of the home, due to mood swings and emotions raised during the initial stages of abstinence from drinking and the challenges faced by individuals in confronting the reasons for their drinking. She further discussed that changes to medication taken by clients for their mental health can affect their emotional reactions and their facing-up to the reasons behind their alcohol dependency. The manager stated that their input on changes to a client’s medication for mental health issues should be sought prior to medication being prescribed. However, this practice is not documented in the policies, procedure or guidance about Mount Carmel. It is required that the home develop a policy and agreement contract with each client and their doctor that details the reason for Mount Carmel to be consulted regarding medication prescribed and this must signed by all parties. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 13 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 home has a satisfactory complaints policy. Staff awareness of abuse issues needs to improve to ensure the well-being and the safety of the clients. EVIDENCE: Since the last inspection one complaint has been received by the CSCI and at the time of writing action is being taken by the home to address the issues raised. Some of the staff spoken to at the home demonstrated a poor understanding of issues relating to the Protection of Vulnerable Adults (POVA). Staff have not received training in this area, and the manager discussed that she has recently acquired a training pack to help train staff in this. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 14 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, 26, 27 and 30 Good improvements have been made to the décor around the home. Further work is required to ensure that some of the bathrooms are refurbished and redecorated. EVIDENCE: Since the last inspection an ex-resident has carried out a lot of decorative work to the home making it a much brighter and homely environment. The only area outstanding from the last inspection is the refurbishment and redecoration of the bathroom on the top floor and the female bathroom on the first floor. This remains in a poor state, with dated furnishings and stained bath and sink areas. These areas are unhygienic as black mould is observed around the bath rim and on the tiles. No progress has been made in these areas and this requirement is restated. During the inspection one client stated that the duvet in their bedroom was too thin and that they would like a thicker one to enable them to keep warm. The inspector discussed this with the manager on behalf of the client, and this is the subject of requirement 6. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 15 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): 35 and 36 The home is working towards having a competently trained staff team to ensure they can meet the all the needs of the clients. Further work is needed to ensure that staff are adequately supported in their work. EVIDENCE: The training of staff at the home is being worked on, with most having recently received training in first aid and fire safety. As detailed earlier, all staff still need to be trained in the Protection of Vulnerable Adults. During the inspection some of the staff were spoken to and stated that they do not receive regular one-to-one supervision from the manager. It is required that all staff receive one-to-one supervision a minimum of six times a year. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 16 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 Clients benefit from their stay at Mount Carmel because the home is run well and in the best interests of the clients. Developments are needed to the reports supplied to the CSCI about the service. EVIDENCE: The manager of Mount Carmel has been in post for a number of years and she demonstrates a good sound knowledge of her responsibilities and the importance of balancing these with the needs of the clients at the home. The manager also has a good awareness of the areas of improvement needed to develop the service further. She does not hold a formal qualification in management, yet stated that she shortly plans to commence the NVQ level 4 in Management. The home continues to provide the CSCI with the reports required in Regulation 26 of the Care Homes Regulations 2001. Further improvements are needed to the information supplied in these reports, where it required that the Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 17 reports also clearly detail how the home is working to meet the requirements of the most recent inspection. The home has taken positive steps to address the use of cleaning products by the clients at the home. Documentation demonstrates that when a client moves to the home a risk assessment is carried out with them to establish that they are aware of the potential hazards of cleaning products, any allergies they might have and their use of protective clothing when using these products. The home has recently had a Legionella risk assessment carried out. The records for reducing the risk of this were not looked at on this occasion but will be checked on the next inspection. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 18 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 3 3 X 3 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 2 3 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 2 2 X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mount Carmel Score X 2 3 X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 3 X DS0000010212.V269399.R01.S.doc Version 5.0 Page 19 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 YA9 Regulation 12(1) & 13(4) Requirement The Registered Persons must ensure that the risk assessment documentation fully outlines all identified risks of clients and the plans in place to manage these (previous timescale not met) The Registered Persons must ensure that clear details of the process of appeal and review of a ‘treatment contract’ is detailed in the Service Users Guide. The Registered Persons must develop a policy and agreement contract with each client and their doctor that details the reason for Mount Carmel to be consulted regarding medication prescribed and this must signed by all parties. The Registered Persons must ensure that all staff at the home receive POVA training The Registered Persons must ensure that the bathroom on the top floor and the female bathroom on the first floor are refurbished and re-decorated (previous timescale not met). The Registered Persons must ensure that all clients have DS0000010212.V269399.R01.S.doc Timescale for action 31/01/06 2. YA7 5(1) 31/12/05 3. YA19 12(2) 31/12/05 4. 5. YA23YA35 YA27YA30 13(6) 13(3) & 23(2)(d) 31/03/06 28/02/06 6. YA26 16(2)(c) 31/12/05 Mount Carmel Version 5.0 Page 20 adequate bedding in their rooms. 7. YA36 18(2) The Registered Persons must ensure that all staff receive oneto-one supervision a minimum of six times a year. The Registered Persons must ensure that the reports supplied to the CSCI clearly detail how the home is working to meet the requirements of the most recent inspection. 31/01/06 8. YA39 26 31/01/06 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. 2. Refer to Standard YA7 YA37 Good Practice Recommendations The Registered Persons must ensure that clear details of the process of appeal and review of a ‘treatment contract’ is detailed in the Service Manual and on the contract. The Registered Manager should obtain the NVQ Level 4 qualification in management. Mount Carmel DS0000010212.V269399.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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. 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