Inspection on 14/05/07 for Muriel Street Resource Centre

This inspection was carried out on 14th May 2007.

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 but made no statutory requirements on the home.

Other inspections for this house

Muriel Street Resource Centre 15/08/07

Muriel Street Resource Centre 31/07/06

Muriel Street Resource Centre 12/12/05

Muriel Street Resource Centre 12/07/05

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 Edi O`Farrell Unannounced Inspection 14 & 23 May 2007 09:25 X10015.doc Version 1.40 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 Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000054457.V331955.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Muriel Street Resource Centre Address 37 Muriel Street Islington London N1 0TH 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) 0207 833 2249 0207 833 2253 muriel@careuk.com Care UK Community Partnerships Limited Mr Philip Hartenfeld Care Home 60 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20) Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Muriel Street is a purpose built 60 bedded care home registered with the Commission for the provision of care for older people with dementia and mental health problems The home is owned and managed by Care UK Ltd, as part of a block contract with Islington Council. It is situated in a residential area within walking distance of Caledonian Road, where there are various shops and public transport. The accommodation is spread over three floors. One floor is residential only, with the others including nursing care. All bedrooms are single with en-suite toilets, showers and washbasins. There are assisted baths on the two nursing floors, and lifts and stairs to all three floors. All parts of the building are accessible to people who use wheelchairs. For safety reasons each floor has a keypad security lock on the exit door. As the service is block contracted the charge to people moving into the home is determined by a financial assessment carried out by Islington adult social services. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this, unannounced, inspection was carried out over two days in consecutive weeks. One inspector, plus a colleague from the London regional office acting as an observer, undertook the first visit. The inspector carried out the second visit alone. The reason for two visits was that it had not been possible to assess some of the key standards on the first day. A total of just over eight hours was spent on the site visits across the two days. Prior to the site visit all information held at our office had been reviewed. This included reports that have to be sent to us on a monthly basis, and about serious incidents. The, then, manager had also completed a pre-inspection questionnaire. This gave us information about things like the number of complaints since the last inspection. It also gave us the names of the people living in the home. Using this information we sent postal surveys to six people on each of the three floors. They were chosen to represent diversity in terms of gender, disability, age, racial origin, and length of time living in the home. Five were returned, mainly completed by relatives. We followed one of these surveys up by phone following the site visits. During the site visits we looked at computerised case records, and discussed these with nurses and managers. We met the people whose care plans we looked at, and compared the planned care with the care being received. We asked for print outs of seven care plans and daily records for a two week period. We cross-referenced these with incident and accident reports. On the staffing side we looked at rotas, and staff recruitment, training and supervision records. Using all the above information we assessed all but one of the key standards and formed the judgements contained in this report. At the end of the site visit we left a form with the home so they could let us know how they felt the inspection went. One requirement in this report has been restated from the last inspection. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission considering enforcement action. What the service does well: The service is block contracted by the London Borough of Islington (LBI), who has strict criteria regarding admission to residential care. This means that people being admitted to the home have been through a full assessment by social services. This includes assessment by a multi-disciplinary team, and the Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 6 information being passed onto the home. Wherever possible the clinical nurse manager then visits the person prior to them moving in, to obtain further information. The home is purpose built, so have full disabled access, and all bedrooms have ensuite toilets and showers. There are a variety of communal areas on each floor, offering a choice of shared space. The home is generally well decorated, furnished and maintained. What has improved since the last inspection? What they could do better: The computerisation of the care planning systems had not necessarily lead to improved care and quality of life for the people living in the home. For example, whilst the need for increased fluids had been identified in the care plans of two people; no checks were in place to ensure that this need was being met on a day-to-day basis. Whilst the intended formats of the assessments and care plans were personcentred, the daily reporting was not. Daily care records were separate from activity records. The latter included comments on the moods and well-being of the people living in the home: the former were simply a list of tasks carried out, such as being got up, fed, bathed, and put back to bed. In addition there was a lack of attention to language in both the care plans and daily records. For example, the use of ‘he’, when the person was female, and vis versa. Also the use of ‘allow’ to, rather than ‘enable’, or ‘support to’. In one case another person’s name was in the care plan. All the above indicated a lack of awareness by staff of person centred planning, and the importance of seeing each person as a unique individual. Whilst each floor had an activity programme, there was no evidence to show that this was accessible to people who were nursed in their rooms. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 7 There was an under-reporting of serious incidents and complaints. This indicated a lack of transparency by the, then 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. The summary of this inspection report can be made available in other formats on request. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are fully assessed before they move into the home. Plans are in place to meet these needs at the stage that they move in. EVIDENCE: As the service is part of a block contract paid for by the London Borough of Islington all referrals are through social service’s care management teams. A social worker assesses each person, with in-put from other professionals as necessary. The community care plan is then passed to the home. Wherever possible the home’s clinical nurse manager visits the person prior to admission to carry out a further assessment. This information is then passed to the nurse in charge of the floor that the person is moving into. Again, wherever possible, an initial care plan is put in place prior to the person moving in. Evidence was seen in the case records looked at that the home continues to follow this procedure, and to collect key information. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 10 A part of this was the ‘Getting to Know You’ questionnaire, which was completed by either the person moving in, or their relatives. This takes a person centred approach, which is important as professional assessments can often, largely, concentrate on medical and nursing needs. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Continuous assessment, care planning, and review is given a high priority, but this does not always mean that the personal and healthcare needs of the people living in the home are met. EVIDENCE: The home’s care records had all been computerised, though some visiting professionals’ records remained as paper. As this change had occurred since the last inspection one of the things we focused on was the accessibility, and usefulness, of the records to staff working on each floor. That is, had they improved practice and led to improvements in the delivery of direct care, and the quality of life of the people living in the home? We discussed the system with the nurse in charge of one floor, and the clinical nurse manager. We asked the nurse to explain how an agency member of staff would know how to meet the needs of the people they were allocated to Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 12 during their shift. We also asked how relatives and friends would know what care their loved ones had received. A sample of seven care plans and the previous two weeks daily records were printed off for us to look at. These were across the three floors and covered a range of health, personal care, and social needs. These included needs specific to racial origin, recent pressure sores, insulin dependent diabetes, recent admissions, being nursed in bed, and severe dementia. In each case we met the person concerned, but were unable to discuss their care with them due to the level of disability. We did, however, compare the care as detailed in the care plan with the care being received on a day-to-day basis. The home had met a requirement set at the last inspection to make sure that all care plans were kept up to date and reflected the needs and wishes of each individual service user. In the care plans we looked at they had also met another requirement that where the person was unable to communicate verbally the method used to conduct the assessment had to be explained in the care plan. The computerised system was comprehensive, and important health and personal care needs were well identified. Where additional assessments were needed, such as risk of pressure sores, these had been carried out. However, as with all new systems, there were some problems. For example, in one case, where the person had been transferred between floors because of changed needs, it looked like the new care plan had simply been added to the old one. There was therefore conflicting information. This meant that it was not clear if the person could walk or not. As the person had had a relatively recent hip fracture this was important information for staff to have. Good written care plans also did not always result in needs being met. In two cases staff were recording the amount of fluids taken per 24 hours. On checking both charts fluid intake was recorded as low over a period of days: an average of 600mls. There was no evidence of staff encouraging the two people to drink. Charts were being used because of identified risks, therefore someone should have been checking the charts and making sure that a higher level of fluid was taken. This is requirement 1. A sample medication audit was carried out on the ground floor. This included checking one medication where the controlled drug recording system had to be used. Whilst the amount of medication was correct, it took some time to work this out. This was because tablets being brought forward were not being recorded on the medication administration (MAR) chart. It was necessary to go back to the record of last received prescription to work out the amount of tablets that should have remained. This indicated that the audits that the home carried out were not actual audits but simply a count of the number of remaining tablets. This is requirement 2. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 13 The separation of reports on health and personal care from daily life and social activities in the system was not consistent with best practice in person centred planning. The danger is, and the daily records indicated this, that nurses and care staff simply see the people who live in the home as a series of physical problems. This ignores the fact that each person is a unique individual, who has had a lifetime of experiences. No matter the level of disability, including dementia, the essential person still remains, and had the right to be treated as such with respect and dignity as a whole person. This is requirement 3. In addition greater attention needed to be paid to the language used in the care plans. For example, gender being incorrect, another person’s name being in the care plan, and patronising language such as ‘allow to’, as opposed to ‘help or support to’. Language is an indicator of attitude and approach, which in these cases were not in line with best practice. Refer to requirement 3. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The daily life and social activities of the more able people are met, but more thought is needed in meeting these needs for people with more complex needs. EVIDENCE: The seven care plans seen were comprehensive and included wishes and preferences. The use of the ‘Getting to Know You’ questionnaire was a positive approach, being based on known good practice in person centred planning. However, it was then disappointing to note that the daily records related purely to health and personal care needs. In the seven seen it appeared that people were simply got up, washed or bathed, fed, and put back to bed. When we discussed this with the clinical nurse manager he printed off another section of the care planning system, which related to activities. This included information about what activities the person had taken part in, and their mood and behaviour, and how this had affected other people. There was, however, no record of what action staff had taken in trying to understand what the person might have been communicating by their behaviour. Nor was there any real strategies for staff to adopt to channel the challenging behaviour. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 15 In two cases where the ‘Getting to Know You’ questionnaire had been completed, the content was not reflected in the care plan seen. In addition the staff member we asked about it was not aware that it was in use. It was concerning to read one comment in a returned survey in response to the question about activities - ‘Bed bound, does not apply’. During our visit we indirectly observed the lifestyle of the people we saw who were cared for mainly in bed. The comment reflects our observations. This is requirement 4. At the last inspection there had been no menu plan in the kitchen, and a requirement was set that this be in place. Since then the head chef had changed, and on a morning visit to the kitchen we saw the daily menu, and the list of special diets. By mid morning the white boards on each floor showed details of the lunch and tea menus, though when asked people still said that they did not know what was for the next meal. The menus seen were varied and offered a wide range of choice. They catered for meat eater, vegetarians, and varying cultural tastes. The food served at lunchtime looked appetising. We also noted that variable sized portions had been served dependent on the known appetites of each person. The rolling menu was mainly cooked from fresh food. It was very positive to see in one of the care plans seen that the person’s liking for food from their homeland was included. The care plan stated that staff should liaise with the kitchen staff to make sure that this happened. It was therefore disappointing to find no record of this person’s wishes and needs for appropriate food was being met. This is requirement “The meals are fine but by the time staff can feed me they are usually cold”. This was a comment from a person living in the home. We fed the above comment back to the home during the second site visit. Managers followed this up the following day by checking that hot meals were not being served prior to staff being available to assist people with eating. They also asked people if they had any concerns about the temperature of the food. The information we received from the manager was that no issues had been raised. We will follow this up at a future inspection. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in the home are not fully protected by the approach to complaints and incidents. EVIDENCE: Complaints, incidents and accidents were computerised. We cross-referenced these records with some of the daily records of the people we case tracked. We also compared the accident reports with the Regulation 37 notifications that the home had sent to us since the last inspection. We discussed some queries with the clinical nurse manager and the acting manager. According to the information sent to us by the manager prior to the site visit there had been three complaints in the previous 12 months. This did not include a complaint that had been sent directly to our office, which we had passed to the responsible individual for a provider investigation. Following our receiving a comprehensive report we had a three way meeting with CareUK and Islington adult social services to discuss the findings. The complaint had been anonymous, allegedly from a relative. They alleged that, following former Islington staff leaving earlier this year, unqualified staff were giving out medication at night. Also that staff who had been recruited to take the place of former Islington staff could not communicate with the people living in the home, due to language difficulties. No evidence was found to substantiate these complaints. Of the other three complains one had been received via Islington, one to Care UK’s head office, and one direct to the home. The latter concerned alleged Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 17 unexplained bruising, which the manager who took the initial complaint had, rightly, identified as having adult protection elements. The, then, manager had investigated all three complaints, and there was nothing in the records to indicate that the complainants were not satisfied with the response. Following the site visits we had a phone conversation with one of the complainants. It was apparent that this person was not satisfied with the response, and we asked the regional manager to follow this up. She has since confirmed that confirmed that a home visit has been arranged. In checking the accident records we found details of a serious skin injury sustained by someone living in the home just before the last site visit. The report stated that poor manual handling might have caused this when a hoist was being used. The records showed that the manager had requested the unit manager to carry out an investigation. It was not possible to be clear what had happened as both the manager and unit manager no longer worked at the home. As neither the complaint that had potential adult protection issues, or the above accident had been reported to us, we contacted Islington contract officer and adult protection co-ordinator following the second site visit. This was to check if they had been informed of the incidents. The responses confirmed that the, then, manager had not followed correct procedure. Four complaints in a year is a very small number for a large care home with nursing. The fact that three of the logged complaints came from external sources, and another manager initially logged the other, raises concerns about possible under reporting. Combined with the lack of reporting under Regulation 37 this raises concerns about safety and protection. This is requirement 6. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People generally live in comfortable, homely and clean surroundings. However, continued problems with plaster and the passenger lift negatively affects their well-being. EVIDENCE: The environment of the home was judged as good at the last inspection. Since then we had not been notified of any significant events relating to the environment that could affect the well-being of the people living there. Therefore our inspection plan did not include a specific tour of the building. Instead we took note of the environment whilst moving around the three floor during the two visits. Overall the home was well decorated, furnished, and maintained. All bedrooms had ensuite toilets and showers, ensuring privacy for the people living in them. Each floor had several communal areas, offering people a Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 19 choice of where to spend their time. These rooms also provided an opportunity for a range of activities to be held on each floor. When we arrived on the first day there was an out of order notice on the passenger lift. The manager informed us that it had recently been repaired, after some delay due to a part having to be specially ordered. He had been informed that morning that it had, once again, broken down. As staff, visitors, and the people living in the home, had been using the service lift he felt that there had been no need to report the initial breakdown to us. However, he went on to state that using the service lift had placed a strain on staff resources. This had been due to the need for staff to access the lift for all visitors, and escort them to the various floors. We considered that the breakdown of the passenger lift did fall within the remit of Regulation 37, and should have been reported to us. This is requirement 7. The lift had been one element of one of the formal complaints, and the manager’s response did indicate strenuous efforts to get it repaired quickly. On the first site visit we also heard about a flood, and on the second saw reference in written documents to low water pressure. We discussed these incidents with the clinical nurse manager. The latter was the most concerning as it had meant that some people living in the home had to use the communal bathrooms, rather than their ensuite showers. It had also meant that staff had had to carry bowls of hot water into bedrooms. This type of event impacts on the health, safety and welfare of both the people living in the home and staff. It should therefore have been reported to us as a Regulation 37 notification. Refer to requirement 7. As stated above we did not inspect all parts of the building. However, in passing one bedroom we noticed that some parts of one wall had the surface plaster missing. As this was quite a large area we were surprised that this room was still being used, given that there were other vacant rooms. It cannot have been pleasant for the person to wake up every morning to look at this wall. We were told that this was also a recurring problem in some other rooms, one of which we looked at, where the damage was more hidden. Staff informed us that this had been repeatedly reported to head office, and hopefully would be shortly repaired. The environment that a person lives in, particularly in their private space in their bedrooms can have a profound effect on a person’s well being. This is requirement 8. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 20 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The company need to place a greater emphasis on training staff to meet the needs of the people accommodated at the home. EVIDENCE: “Staff are always willing to listen and take on board any worries we might have”. The above is a comment received from a relative via the postal survey. The people living in the home spoken to during the first visit were unable to give their views due to the level of disability. However, during both visits we indirectly observed staff working with people, and having warm and affectionate relationships with them. Training records showed that there had been a training programme in place since the last inspection. This had included Health and Safety, food safety, induction and customer care. We looked at two recent recruitment files. All required documents were in place, but in one case it was not possible to verify that the previous employer had supplied either reference. We discussed this with the area manager, who forwarded an amended copy of the reference request form to us immediately following the site visit. The use of the new form will increase protection for Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 21 people living in the home, as the person supplying the reference is now asked to provide a company stamp. At the last inspection some staff were still employed by Islington, with protected terms and conditions. This created problems in both the organisation and management of the home, and had created conflict between staff at times. On this visit all staff were employed by CareUK. Several ex Islington staff had chosen to leave, whilst others had transferred. These changes have had a positive effect on the running of the home. As one relative commented in the postal survey. “This home is well run with caring staff and support team. There now seems to be a permanent staff which can only be good for clients and family”. As stated earlier in this report the computerised care plans were comprehensive. However, there were several areas of concern, which were also found in the daily progress reports. The issues identified indicated a general lack of understanding, by staff, of person centred planning, good practice in working with people with dementia, and the underpinning values of dignity and respect. For example, the use of he or she, when the person was of the opposite gender and the use of another person’s name in the wrong records. Another example was where it was documented in a care plan that a person be ‘allowed’ to speak in his own language and ring his family abroad. These points were discussed with senior managers during both the first and second visit. They were well aware of the training needs. This is requirement 9. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 22 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home needs strong leadership and management with greater attention being paid to the quality of life of all the people who live there. EVIDENCE: The registered manager left his post between the first and second visit. Pending the appointment of a new manager the deputy manager was acting up into the post. The clinical nurse manager was supporting her in this role. In addition the area manager was based at the home two to three days a week. In discussion during the site visits all three managers demonstrated a good level of awareness of the strengths and weaknesses of the service. They provided evidence that many of the issues identified in this report had already been raised with staff. We are therefore confident that adequate management arrangements are in place pending the appointment of a new manager. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 23 The judgements in previous sections of this report have contributed to the judgement in this outcome area, which is based on information gained between this and the previous site visit. For example, the lack of regulation 37 notifications, including complaints and serious incidents: in addition, the lack of checks on basic care, such as the success, or otherwise, of fluid charts. Our impression was that the implementation of the computerised care planning system had taken a high level of management time. The provider needs to consider how the home can be best managed so as to meet peoples’ needs and maximise their quality of life. This is requirement 10. In response to the requirements at the last inspection supervision records were in place. We looked at a sampple and were pleased to see that these included support to staff where they had to deal with racial abuse from a particular service user. The acting manager was able to demonstrate how she supported staff in dealing with these situations. Appraisal had not yet been started. The acting manager reported that this had been because the then manager had not been appraised and was of the view that the cascade needed to start with him. This is requirement 11, which is restated from the previous inspection We looked at the records of people’s personal finances that were handled by the home. We discussed the system with the administrator, who was responsible for this. This was an effective system that safeguarded people, and provided a clear audit trail. At the last inspection a requirement had been set for fire drills to be fully recorded. This was because the manager had not been able to show how drills had been handled, for example, if everyone had responded promptly and how long evacuation had taken. At the second of the site visits for this inspection we looked at the records, and discussed them with the handyman, who was responsible for this element of the service. The requirement had been fully met, with the records showing who had been involved in each drill, and how evacuation could be improved. A sample of other health and safety records, such as water and room temperatures, were sampled. All were up-to-date and correct. Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 2 X 3 Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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 OP8 Regulation 12 (1) Requirement The registered person must make sure that, where health needs are identified in care plans, checks are in place on a daily basis to make sure that these needs are being met. This is to safeguard the health and welfare of the people living in the home. The registered person must make sure that systems are in place for regular medication audits. This is to safeguard the health and welfare of the people living in the home. The registered person must make sure that all practices, including written records, within the home are conducted in a manner that respects the dignity of the people who live there. The registered person must make sure that all people living in the home have a programme of suitable activities. This must include those people with complex needs, and those who are nursed in their rooms. This is so that all people living in the DS0000054457.V331955.R01.S.doc Timescale for action 31/07/07 2 OP9 13 (2) 31/07/07 3 OP10 12 (4) 31/07/07 4 OP12 OP14 12 & 16 (m) & (n) 31/07/07 Muriel Street Resource Centre Version 5.2 Page 26 5 OP15 12 (4) & 16 (2) (i) 6 OP16 OP18 13 (6) 22 & 37 7 OP19 37 8 OP19 23 (2) (b) 9 OP27 OP30 18 10 OP31 12 home have as full a life as possible. The registered person must be able to demonstrate that peoples’ dietary wishes and needs are being met. This is particularly important where the person originates from a different culture to the majority of the other people living in the home. The registered person must make sure that all significant incidents, including relevant complaints, are reported to the commission. This is in order to safeguard and protect the people living in the home. All complaints must be fully investigated and recorded. The registered person must make sure that environmental changes, that impact on the people living in, working at, or visiting the home, are reported to the commission. This is to safeguard the health and welfare of the people living in the home. The registered person must make sure that rooms that people live in are fit to be inhabited. This must take account of the potential impact of the physical environment on the well being of the person. This is to safeguard the health and welfare of the people living in the home. The registered person must make sure that all staff are trained to meet the particular needs of the people who live in the home. The training must take account of known best practice in the care of people with dementia. The registered person must make sure that the home is DS0000054457.V331955.R01.S.doc 31/07/07 31/07/07 31/07/09 31/07/09 30/09/07 30/09/07 Page 27 Muriel Street Resource Centre Version 5.2 11 OP36 18(2) managed in a way that meets peoples’ needs and maximises their quality of life. The Registered Person must ensure that all care staff have an appraisal, which is reviewed each year. This requirement is restated, previous timescale of 31/10/06 not met. 30/09/07 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 Muriel Street Resource Centre DS0000054457.V331955.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000054457.V331955.R01.S.doc Version 5.2 Page 29 - 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. 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