Inspection on 15/08/07 for Muriel Street Resource Centre

This inspection was carried out on 15th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 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 Pippa Canter Unannounced Inspection 15th August 2007 10:00 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.V344542.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.V344542.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 manager.muriel@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd Post Vacant 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.V344542.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th May 2007 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.V344542.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 one day from mid morning until late afternoon. A total of six hours was spent in the care home. It was the second unannounced key inspection since the 1st April 2007. The previous inspection in May had recorded poor outcomes for service users. As a result the service was asked to submit an improvement plan and a meeting was held between representatives of the Commission for Social Care Inspection and acting manager and operational director of Care UK Ltd. Prior to the visit we reviewed all the information we had about the home. This took account of the improvement plan, the monthly reports sent to CSCI about the conduct of the home and the notifications about serious incidents. For this inspection there was a failure to return the Annual Quality Assurance Assessment, which would have provided very useful information in planning the inspection. A requirement has been made about this. A sample of surveys for people living in the home, their relatives as well as health and social care professionals were left in the home for distribution and return to CSCI. To date one relative and twelve residents have returned surveys. Their feedback is included in this summary and throughout the main body of the report. During the site visit we looked at six care plans and the accompanying daily records for the previous week. The choice was based on the diversity of the residents in terms of their gender, disability, age, racial origin and length of time living in the home. We met the people whose care plans we had looked at and made comparative study between the care recorded on the records to the care being received by the residents. We looked at the accident and incident reports. We looked at a variety of records relating to staff, including rotas, staff recruitment records, training files and appraisals documentation. We also had took the opportunity to use the SOFI inspection tool, which is the Short Observational Framework Inspection. This entails a period of observation in a communal area of about five people who live in the care home. On this occasion the observation was done over a lunch time period on one of the units. Using all the above information we assessed whether there had been any improvement in the outcomes for service users. At the end of the site visit we fed back our general findings to the deputy manager and the clinical nurse specialist. We left a form with the home so they could let us know how they felt about the inspection process. What the service does well: Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 6 The home is purpose built, so has full access for people with disabilities. All bedrooms are single occupancy and have an ensuite toilet and shower. There are a variety of communal areas on each floor offering a choice of shared space. Over the home the home was found to be clean and provided a safe and pleasant environment for the people who live there. Residents are thoroughly assessed prior to admission and can be assured that their personal and health needs can be met. One relative commented that the home is good at the following: “The home is always clean and smells nice.” “The food is good” “Staff always helpful and polite.” What has improved since the last inspection? What they could do better: Areas where the home could improve have been discussed with the acting manager and the clinical nurse specialist. Poor recording needs constant monitoring. Staff need to be careful when offering residents choices making sure they give them enough information to make an informed choice. The Annual Quality Assurance Assessment must be completed within the required time scales. Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 7 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.V344542.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.V344542.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. People moving into the care home can be confident that their needs have been fully assessed. Plans are in place to meet their health and personal care needs from the day of admission. EVIDENCE: There is an established assessment process when a person is referred to the service. All referrals are via the care management procedure, whereby a social worker will assess each new referral with input from other health and social care professionals. This information is translated into a community care plan, which is sent to the care home. Wherever possible the home’s clinical nurse manager visits the person prior to admission to carry out a further assessment to assure that the home can meet the person’s needs. This information is Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 10 passed to the nurse-in-charge on the relevant unit and an initial care plan is developed. Six people were case tracked as part of this inspection and all had assessments on file and it is clear that key information continues to be collected. Muriel Street Resource Centre DS0000054457.V344542.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 good. This judgement has been made using available evidence including a visit to this service. The system of continuous assessment, care planning and review ensures that the personal and healthcare needs of people living in the home are being met. EVIDENCE: The homes care records are computerised. A sample of six care plans and the previous two weeks daily records were looked at. Two people from each unit were case tracked. The sample was based on 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 care records were found to be comprehensive, up-to-date and clearly identified the important health and personal care needs. Residents are Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 12 assessed as part of a risk management system and plans were in place to reduce any risks in respect of manual handling, tissue viability and nutrition. The home has met a requirement set at the last inspection. Previously the fluid intake charts were not being monitored therefore it had been unclear whether staff had been encouraging people at risk to drink. At this inspection, fluid balance charts were checked. Entries were more frequent and showed that sufficient fluids were being taken. A requirement had been made at the last inspection relating the management of medication. As a result a Pharmacist from Commission for Social Care Inspection completed an inspection in the care home. The outcome of this inspection showed that the quality in the area of medicines management was considered only just adequate. In response the care home developed an action plan. It was the progress of this action plan that was assessed as part of this inspection. The management of the home has introduced a system of audits. These are proving to be effective and there has been an improvement in the management of medication. One such audit had identified a mistake in the controlled drugs register on one of the units and this had been reported and dealt with appropriately. The medication administration records (MARS) were noted to record accurately the administration of drugs. Allergies specific to residents are recorded on the MARS sheets and known to staff as well. Records of disposal are also available on all the units. Lancets for professional use have been ordered so that diabetic residents will have their blood glucose levels monitored on a regular basis. Overall the care home is meeting with the medication standard. Discussions with staff and a short period of observation highlighted that staff respect the privacy and dignity of people in their care. Feedback from people living in the service confirmed the inspector’s observation. An inspection of the care records showed a clear improvement in the language being used. However there was still an incident of the wrong gender being used and another showing the improper use of language. These were discussed with the management team at the end of the inspection and they gave their commitment for greater vigilance and re-training where required. Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. The improvements will make sure that all people living in the home will have access to stimulation, preferred activities and a more positive experience. EVIDENCE: At the previous inspection the quality in this outcome area was judged as adequate. Requirements had been set in respect of a programme of suitable activities especially for people with complex needs and cognitive impairment as well as ensuring that cultural needs are met in respect of food choices. This inspection highlighted that progress had been made through the development and implementation of an improvement plan. Feedback from people living in the care home confirmed that they had a range of activities to choose from. During the inspection there was activities taking place in each unit at different times of the day. Service users and where appropriate relatives have been canvassed about the particular choices and individuals’ interests. This information will be collated and fed into an activity programme for individual residents. The topic of activities has been discussed at a Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 14 relatives meeting. The outcome of which, was to improve the activities for people with Dementia. To this end a Dementia Care training session has been organised for staff. During periods of observation by the inspector there was clear evidence of positive interaction between staff and residents. Residents were being engaged in a constructive way. There is an improvement in the daily recording which shows that residents are being engaged in more that personal care eating and sleeping. Feedback from relatives was that they are made to feel welcome into the home and are generally kept up to date with important matters affecting their loved ones. Feedback from the residents about the quality and variety of the food was generally positive. The menu has been revised and is on a four weekly cycle and the catering service within the home has been reviewed. Comments from service users included, “ Yes I like the meals”, “The food is always nice” as well as “Sometime the meal is good but not always the soup” and “The meals are good but there could be more meat and I would like more choice for breakfast e.g. cooked breakfast in the week not only on a weekend.” During a short period of observation over a meal time, the inspector saw that staff tried to make the meal a social occasion, this included inviting relatives to join their loved one for a meal. Staff assisting people to eat, sat with the person and engaged the people sitting around the table in conversation. Choices were extended and residents were being given sufficient time to eat their food. However there were incidents where practice could be improved. A staff member sat with their back to other people sitting around the table, which was not ideal when trying to stimulate conversation and interest the meal. Although residents were being offered the choice of a pudding or a drink, staff did not explain what those choices were. Cultural needs are being met but staff need to record in the care plan whether a person from a different cultural background has an eclectic taste in food or wishes to eat only their ethnic meals. Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. People living in the service can be assured of protection under the home’s improved approach to complaints and adult protection. EVIDENCE: A requirement was set at the last inspection to make sure that all significant incidents, including complaints, are reported to the Commission for Social Care Inspection (CSCI). Evidence shows that the service has a robust complaints’ procedure and feedback from people living in the home and their relatives is that they know whom to approach if they are unhappy with their care. Complaints are being recorded and investigated. The management team are keeping CSCI informed of any untoward incident. An incident within the scope of the adult protection process has occurred and the acting manager has responded appropriately. Other notifications have shown that the acting manager and clinical nurse manager are monitoring the practice in the home and taking appropriate action where necessary. Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, clean and homely environment for people who live there. EVIDENCE: Requirements had been set at the last inspection in respect of a faulty lift and the need for re-decoration and repairs to plastering in some bedrooms. The work has been completed. Feedback from people living in the home was that the environment was always fresh and clean, and they felt comfortable and safe. A general tour of the home was made and the areas used or occupied by the people being case tracked were looked at with their permission. During the inspection, it was evident that further work was being carried out to the hot Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 17 water system. This was to be drained and the manager was reminded to send a notification if this was likely to affect the health and safety of residents and staff. Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. The home has a team of staff who, now all have the knowledge and skills to meet the needs of the people living there. EVIDENCE: The overall quality of this outcome area was judged to be adequate, as requirements had been made at the last inspection in respect of Standard 27 and Standard 30. In the interim external training specialists have been conducting training specifically aimed towards those service users living in the home. Training records and discussion with staff confirmed that training is taking place. Residents said that staff are available when needed and they do not feel rushed. At lunchtime there is sufficient staff deployed to make sure that service users are assisted with eating and drinking. Discussions with the clinical nurse manager identified that nurses competency will be assessed in light of one of the incidents, which has been reported. A comment from a postal survey was “We do wonder if all the staff have knowledge of all the patients’ history as each is an individual case and there Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 19 has been a turnover of staff.” Discussions with staff and an inspection of the care records showed that they do have knowledge of the people in their care. A selection of recruitment files were looked at and all the required information was available. The service has a robust recruitment and selection process that protects people living in the home. The service has responded to the previous poor inspection report and the improvement plan has implemented more proactive monitoring by the provider, senior staff within the home and the additional training has fostered a better person centred approach. There has been an improvement in the language in the care records although instances of poor recording could still be found. This is an indication that continuous monitoring is still necessary. Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 20 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home will be run in the best interests of the service users. Attention needs to be paid to fulfilling regulatory responsibilities. EVIDENCE: The management arrangements remain as previously. The deputy manager is acting up with support from the clinical nurse specialist and the operations director provides additional back up. This has proved to be a satisfactory arrangement. It has provided stability in the absence of a manager, as well as formulated and implemented the improvement plan. The vacant manager’s post has been re-advertised both internally throughout the organisation and externally through a recruitment consultant. The provider must keep the Commission aware of any progress in this area. Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 21 The judgements in previous sections of this report will have contributed to the judgement in this outcome area, which is based on information from previous inspections, the current site visit, an improvement plan and a meeting with the acting manager and operations director. It also includes the receipt of regulation 37 notifications spanning serious incidents. The increased management time in implementing and monitoring the improvement plan in the home cannot be underestimated in maximising the quality of life for people who live there. However it needs to be recorded that there was a failure to return the Annual Quality Assurance Assessment by the required dead line and again following a reminder. Appraisals have been implemented and completed. An organisational chart is available within each unit. Copies are available on individual personnel records. Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 22 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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 3 Muriel Street Resource Centre DS0000054457.V344542.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP33 Regulation 24 Requirement It is a requirement that the Annual Quality Assurance Assessment is completed with the timescale set. Timescale for action 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.V344542.R01.S.doc Version 5.2 Page 24 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.V344542.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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