Inspection on 12/07/05 for Muriel Street Resource Centre

This inspection was carried out on 12th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 but made no statutory requirements on the home.

Other inspections for this house

Muriel Street Resource Centre 15/08/07

Muriel Street Resource Centre 14/05/07

Muriel Street Resource Centre 31/07/06

Muriel Street Resource Centre 12/12/05

Muriel Street Resource Centre 02/06/04

Muriel Street Resource Centre 27/04/04

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

CARE HOMES FOR OLDER PEOPLE Muriel Street Resource Centre 37 Muriel Street Islington London N1 0TH Lead Inspector Joyce Grant Unannounced 12 July 2005 10:00am th 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 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 Older People. 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. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Muriel Street Resource Centre Address 37 Muriel Street Islington London N1 0TH 020 7833 2249 020 7833 2253 admin.muriel@kuk.com Care UK Community Partnerships Limited 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) Standing Manager Betty Couch Care Home 60 Category(ies) of DE (E) Dementia-over 65 (40), MD (E) Mental registration, with number Disorder - over 65 (20) of places Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Admittance of person under 65 is for Mrs TT only. DOB 8/10/1948. This condition will apply until the named person leaves the home or turns 65. Date of last inspection 2nd June 2004 Brief Description of the Service: Muriel Street is a newly purpose built 60 bedded care home registered with the Commission for the provision of Care for older people suffering primarily for Dementia and Mental Disorder. The home is owned and managed by Care UK Ltd in partnership with Islington Council. It is situated in a residential area within walking distance of Caledonian Road, where there are various shops and methods of public transport. The home is also adjacent to Regents Canal. The accommodation provided is as follows: Ground Floor 20 beds - Nursing Plus for people with mental disorder 1st Floor 20 beds - Nursing for people with dementia 2nd Floor 20 beds - Residential offering Personal Care for people with Dementia The home consists of all single bedrooms with en-suite toilets, showers and washbasins. There are also assisted baths on the two Nursing floors. Each floor is divided into two units accommodating 10 service Users in each. This includes separate dining rooms and lounges. The home is pleasantly furnished throughout. Direct care of the residents is provided by qualified nursing staff, both Registered General Nurses, Registered Mental Nurses and Care Workers. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first announced Inspection to Muriel Street for 2005. The Inspection was conducted over 7 hours, in the main key standards were assessed and the seven previous Regulatory Requirements were followed up. I was well assisted by the new Manager and staff in the carrying out of this Inspection. What the service does well: What has improved since the last inspection? Since the last Inspection an Activities Co-ordinator has been employed. Service Users have been individually assessed and their interests and preferences have been incorporated into activity programmes that ensure and build daily routines. Group activities are also offered on a weekly timetable encouraging participation and the building of relationships amongst service users. There has been improvement in care planning aand record keeping, generally. The home benefits from a more stable and united Staff Team who has worked together to overcome the difficulties arising out of the merging of three different teams. Both the Manager and Staff members have commented on positively on the teams overall improvement. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 6 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. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Key Standard 6 is not appplicable to this service Provider Service Users needs are fully assessed and Care Plans are clear and comprehensive reflecting individual needs. Service Users and their relatives can be assured that their needs will be appropriately met. EVIDENCE: A total of five service user files were inspected reflecting each of the units within the home; there were two from the Residential unit, two from the Nursing unit and one from Dementia and mental health unit. Each Service user file demonstrated that comprehensive assessments provided the basis for equally thorough Care Plans. It was also clear that these records were regularly updated reflecting the current and changing needs of the service user. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 11 There is a comprehensive Care Planning System in place, which clearly sets out the personal, social and health needs of service users. This ensures that service users needs are readily identifiable and their needs appropriately met by staff. The procedures for the administration of medication are good ensuring the safe management of drugs and medicines to service users. Care Plans reflect the personal views and wishes of the service user and relatives in respect of ‘Death and Dying’. EVIDENCE: As previously stated under Standard 3 a total of five Service User files were inspected and discussed with staff on the unit. Individual Care Plans wholly set out in detail the service users personal and social care needs and the relevant steps that need to be taken in order ton meet those needs. Risk Assessments are included in each plan carefully detailing the level of care, supervision, support and aids needed in the promotion of safety and prevention of falls. Each care plan is updated on a monthly basis, however staff are clear that relevant and significant changes are recorded between summaries in order to reflect changing care needs. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 10 Service Users health needs are identified and assessed accordingly. The necessity and availability of Nursing staff in the unit provides professionally trained staff to assess for example/in particular service users at risk of pressure sores and the Care Plan includes an assessment framework to assess Tissue Viability of service users at risk of developing pressure sores. Additionally, monthly monitoring of psychological health assess the level of dementia where appropriate Individual medication chart records current medication prescribed and any changes made. The Pharmaceutical establishment providing the medication have provided training for medication to Muriel Street. This training is routinely maintained and staff training files inspected provide certification of this training. The room used for drug storage was appropriately air conditioned with two wall thermometers registering the temperature. The room temperature was 20C. Fridge temperatures were recorded at between 2 and 8degrees celsius , which is within normal range. Arrangements for Controlled drugs were checked assessed as satisfactory including correct records of balances, storage and records made for receipt and administration of such. Standard 11 was inspected following the previous Requirement made concerning the need for Care Plans to reflect service users wishes in relation to ‘Death and Dying’. The Registered Manager is aware of past concerns which relate to this aspect of the Care Plan, this has been raised in ‘Team Briefings’ and will be raised at the relatives meeting on 12th July 2005. In discussion with Unit manager and Registered Nurse concerning one of the files inspected it was clear that both were aware and committed to complying with this requirement the file reflected a clear action plan in respect of this standard and recorded the Service User and the Relatives wishes in regard to event of death and dying. This requirement has been met. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 Service Users will stand to benefit from individual and group activity programmes which provides routine, promote participation and foster friendships within the group. Relatives and friends are welcomed and feel able to visit without restriction consequently service users are therefore able to maintain good and consistent contact with family and friends. Meals are provided from menus that offer both choice and variety catering as far as is possible for the diverse needs of the service users. EVIDENCE: Standard 12 was made a Requirement at the last Inspection. This was made in respect of the development of a daily activity plan for each of the three floors. An Activity Coordinator has been employed to develop and lead the Activities service within the home, he has assessed both individual and group needs and devised programmes accordingly. The Coordinator has devised individual activities programme which is included as part of the Care Plan one of the files inspected had a detailed daily activity programme incorporating the general preferences, as well as paying attention to religious, cultural needs of the service user. The group programme offers daily morning and afternoon activities and is posted on the communal dining room notice board. In discussion with one service user and relative bingo was a clear favourite though her relative stated that ‘she did not like to get involved too much.’ This Requirement has been met. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 12 Service Users benefit from living in a home that is welcoming to their relatives and friends who are encouraged to call in and visit without appointment. A Kitchenette on each floor is made available for visitor’s use with laminated posters is posted on the notice board to emphasise this availability. A relative stated that it was possible ‘I pop in when I can, my husband and my sister pop in … sometimes I take mum for a walk and its no problem.’ The service user stated ‘I love when they visit.’ The issue of outings and holidays for service users, who are able to part take was discussed. The manager and the newly appointed activities organiser confirmed that they are reviewinsuch arrangements with service users on an individual basis. Changes have been undergone in relation to the planning of the weekly menu. The current format of the menu has only been in operation for the past two weeks. It offers both a standard and alternative menu that allows for the provision of choice. The menu is planned each week following the inclusion of information provided by key workers who have sought the views of respective service users. The chef was absent through illness and the menu was rearranged for the day in accordance to the views and preferences of the service users. The meal served reflected the change in the menu. One floor had the menu written up on the white board. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The system for recording of Complaints remains unclear. Adult Protection Training for all staff has not been undertaken consequently staff members demonstrate a lack of clarity about procedures and lack of awareness concerning issues of adult protection. EVIDENCE: Standard 16 was made a Requirement from the previous Inspection. The Requirement stipulated that Complaints records need to be kept securely together on a separate file and that recrods in respect of each complain need to demonstrate outcomes and action taken. This requireement has still not been met aand has been repeated. Standard 18 was made a Requirement from the previous Inspection. The Requirement stipulated that all staff members be trained in the protection of vulnerable adults. Of the two Staff Training Files inspected there was no record that this training. A number of staff were asked what action they would tke in the event of an allegation of abuse and the answers given demonstrated that the action they would take would be inappropriate. There was some documentation in place in respect of adult protection matters, such as definitions of abuse. However, there was no procedure evident on the steps a member of staff should take when an allegation of abuse is made. The Manager was also asked to obtain a copy of Islington Council’s adult protection policy and procedures. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26 Service Users benefit from living in a home that is well maintained and offers a comfortable and homely environment. The service user is assured of a home that is regularly cleaned and pleasant to live in. EVIDENCE: The standard of the environment within this home is good, the décor is tasteful and provides a homely and attractive setting for service users. The home is spacious offering not only personal and communal space but also opportunity for service users to find a quiet corner at any point on each of the floors. The home was clean and each room during the morning inspection was being cleaned and each bed changed. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29,30 Staffing levels within the home are good and the complement of staff reflect an appropriate combination of skill and competency to meet the needs of service users. Recruitment process is appropriately carried out ensuring the protection of service users. Service Users are cared for by competent staff whose training and development needs have on the whole been met. EVIDENCE: The number and skill mix of staff on each floor was verified. The ground floor requires 2 qualified Nurses one of whom is a mental health specialist and four care staff. The Inspector met both Nurses and was informed that the full complement of care staff were on duty; a number of care staff were observed on duty. The ratio of staff is halved for night duty. On the first floor, the Inspector met with two qualified Nurses and Team Leader, a number of care staff were also observed on duty. On the Residential floor the inspector met with the Unit Manager and Team Leader and observed a number of Care Staff on duty. Inspection findings suggest staffing levels appropriately meets the assessed needs of the service users. Two Personnel files were inspected and both files demonstrated that the home follows a thorough Recruitment process. Both files held two written references, and evidence of satisfactory checks, one CRB and the other where there was no CRB document a letter from the Local Authority verified that these checks had taken place. The Inspector was informed that three of the four Care Staff on the ground floor were qualified to NVQ 2-3. The Unit Manager on the Residential floor is Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 16 qualified to NVQ 4, her Training Record was not available for inspection upon request. The Team Leader is completing NVQ to level 2-3. The Team Leader’s (Nursing Floor) training record was also not available for inspection upon request. The Manager is currently developing a new Internal Training Programme. Internal training to date was being coordinated by Care UK centrally, this will now be coordinated on a local basis with Muriel Street taking responsibility for their own staff training. The Inspector checked two personal training files and it was found that Mandatory training for First Aid, Moving and Handling, Food and Hygiene were recently updated. There was sufficient evidence to suggest that training needs have been met. The new training programme will be followed at the next Inspection. However as stated under Standard 18 Adult Protection Training needs have not been met Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 The home has recently recruited a Manager whose fitness as the Registered Manager will be assessed as part of his registration with the Commission. The service Users stand to benefit from a more settled and integrated staff team who are working together to promote an efficient service of care. EVIDENCE: The Manager has recently taken up this post and has informed the Inspector that an application for Registration has completed and is due to be with the Commission shortly. Following the merging of three establishments the staff team have entered a more settled phase and the home is functioning with a greater level of peer support and integration as one team. Both the Manager and staff have commented positively concerning the improvements. The Requirement concerning roles and job descriptions has been met. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 18 Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 x x 3 x x x x x Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 20 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 16 Regulation 22 Requirement Timescale for action 30/08/200 5 2. 18 & 30 13 (6) The Registered Manager must ensure that the homes complaints records are kept together on a separate file and that each complaint is recorded with actions taken and outcomes. This requirement is re-stated . 30/08/200 The Registered Manager must 5 ensure that all members of staff receive training in the protection of vulnerable adults and that there is a procedure in place on the step by step action to be taken when an allegation of abuse is made. A copy of Islington Councils Adult Protection Policy and procedures must also be made available at the home. 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. Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 21 Refer to Standard Good Practice Recommendations Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Centro 4 20-23 Mandela Street Camden Town London NW1 0DW 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 Muriel Street Resource Centre G58 s54457 Muriel St v177557 120705 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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