Inspection on 31/07/06 for Muriel Street Resource Centre

This inspection was carried out on 31st July 2006.

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 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 15/08/07

Muriel Street Resource Centre 14/05/07

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 Ms Jill Marriott Unannounced Inspection 31st July 2006 11:30 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.V287250.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.V287250.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.burroughs@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.V287250.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Admittance of a 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. 31/01/06 Date of last inspection Brief Description of the Service: Muriel Street is a new purpose built 60 bedded care home registered with the Commission for the provision of Care for older people with 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. Theere is a block contract in place with Islington Council. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 31/07/06 it was the first visit for the year 2006/7. The inspection began at 11.30 am and took 7 hours to complete. Two inspectors Jill Marriott and Edi O’Farrell conducted the inspection and all of the core standards were assessed. The homes manager Phillip Hartenfeld was on site throughout the day. One requirement was made at the last random inspection, which took place on the 31/1/06. This requirement is now fully met. The inspectors would like to thank members of staff and service users for their co-operation during the inspection process. What the service does well: What has improved since the last inspection? What they could do better: There are a number of areas where improvements could be made at this home. During this inspection a number of requirements have been made in respect of the following: Care plans must be reviewed regularly and kept up to date. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 6 A record of activities must be available for all service users. A menu plan must be available each day. Issues raised during the inspection process must be investigated. All care staff must have regular supervision and an appraisal, which is reviewed each year. Fire drills must be recorded with time scales of evacuation, issues arising and actions taken. Two recommendations have also been made. 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 DS0000054457.V287250.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 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 the following standard(s): Standard 3 was assessed at this inspection. Standard 6 is not applicable Quality in this outcome area is good. Policies and procedures clearly indicate that a full needs assessment is carried out for each service user at the referral stage of the placement. EVIDENCE: Service user files were tracked as part of the inspection process. Files were seen on each of the units. Files from the residential unit clearly indicated the needs of the service user at the pre admission stage and this was incorporated into the care plan. There was also a pre-admission assessment’s on the files of the service user on the other two floors, which also informed the initial care plans. The home has specific policies and procedures to follow regarding needs led initial assessments and these appear appropriate. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 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 the following standard(s): Standards 7, 8, 9 and 10 were assessed at this inspection. The quality in this outcome area is adequate. Service Users needs are initially fully assessed. Initial Care Plans clearly reflect individual needs. The home must ensure care plans are reviewed regularly and include relevant up to date information. EVIDENCE: In general service users files reflecting the services provided for them. Each service user file seen by the inspectors demonstrated that a comprehensive assessment had been provided at the beginning of the placement. These looked at health, personal and social care needs. It was not so clear that these records were regularly updated to reflect the current and changing needs of service users. For example one service users plan on the residential floor included a cognitive record, which clearly shows it must be reviewed every three months. The cognitive chart seen had been reviewed only on 04/02/05 and again on 04/03/06 this is important information and needs to be reviewed according to the time scales stated on the care plan. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 10 The files tracked on the first floor showed some evidence of good practice. Other file entries seen were of concern. On the 18/01/06 a nursing care needs assessment was undertaken for one resident the assessment states as follows “the service user is totally disorientated to time, place and person”. The person referred to in this assessment does not speak any English. There was no evidence on the file to show how this assessment had been undertaken. The pre inspection questionnaire received at the Commission for Muriel Street states that there are five service users whose first language is not English. The questionnaire also states that none of the service users have special communication needs. This information needs to be reviewed. Another entry on the same file dated 27/07/06 said the service user seemed to be leaning to her left side there was no evidence of any further action taken. A further entry on 30/07/06 suggested the person had been leaning forward and was at risk of falling the entry stated that the service user was put in a chair with a safety belt. There was no evidence of a risk assessment or any discussion regarding this person being strapped into the chair. Records indicate that this service user has not been referred to a GP since 24/04/06. No activities have been recorded on this file since 05/06/06. A file for a service user on the ground floor of the home showed the care plan had been reviewed following a file audit. The new care plan had been introduced using a completely different format to the others seen by the inspectors. When asked about the plan, the nurse in charge said she was aware that different types of care plans were in use and that this practice was confusing. There was no clear guidance to suggest which care plan should be used. None of the service users in this home are self-medicating. The medication trolleys and MAR charts on all three floors were checked during the inspection all medication records include a picture of the service user and records were signed. The signatures of members of staff who given medication are kept at the front of the medication file. Medication trolleys and cabinets were clean and tidy. It was clear from discussion with service users that they felt they were treated with dignity and respect. The inspectors observed staff and service user interaction, which confirmed this. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 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 the following standard(s): Standards 12, 13, 14 and 15 were assessed at this inspection. Quality in this outcome area is adequate. General activities are available on all floors of the building although it is difficult to tell if these do or don’t take place. Relatives and friends are welcomed and are able to visit the home without restriction. On the day of the inspection the meal seen did appear varied and nutritious, however there was no evidence of a menu plan available. EVIDENCE: In general a range of lifestyle experiences are available to service users. There was no evidence on files to show how activities are planned for service users from different cultural groups specifically those who have English as a second language. The home now has a full time activities co-ordinator in post. The activities room was full of interesting things, for example old and interesting newspapers with specific articles, musical equipment and art and craft facilities. Each lounge had an activities chart on the wall. However on the day of the inspection the activities co-ordinator had gone out with some of the service users and this had affected the activities arranged on each of the floors. In one lounge service users were watching a music video. In other lounges service users were watching TV. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 12 Activity plans said thing like a walk about or singsong. One file showed that the service user likes to shop on discussion with the service user and from the file tracked it was clear that this person went shopping with staff at least once a week and sometimes more often. It was difficult to tell from other files seen exactly how much activity does take place. A file tracked on the first floor had no activities recorded since 05/06/06. The pre-inspection information received at the Commission shows that service user go out in the community, to the cinema and shopping and attend local church services. In house activities include keep fit, live music sessions, reminiscence groups, sing along, film club and poker club. The menu offers both a standard and alternative meal, which allows for the provision of choice. The menu for each floor is passed to the cook at 3pm each day so the following days meals can be planned. On the day of the inspection the inspector asked to see the menu plan for the day. The cook said this had not come down from the units on the previous day when asked how he knew what people wanted he said it was written by the staff from the units on a white board in the kitchen. The white board in the kitchen was completely clear, there was no evidence that service users did have a choice of meal on that day. Overall service users said the food was very nice. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 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 the following standard(s): Standards 16 and 18 were assessed a this inspection. The quality in this outcome area is adequate. The system for recording complaints is clear. Adult Protection Training has been provided for staff on 11/01/06 and 02/03/06. One issue, which needs to be investigated, was raised with the manager during this inspection. EVIDENCE: The complaints book was seen during the inspection. Three complaint were recorded two had been dealt with and one was in the process of investigation. Complaints are handled appropriately. With regard to adult protection the home has an appropriate protection policy and the manager has a copy of the Islington Adult Protection policies and procedures. Two training sessions have been implemented this year and staff who spoke with the inspector appeared to understand the procedure to follow should there be an allegation made. Notifications regarding allegations have also been received in appropriate format at the Commission for Social Care Inspection. While the inspectors were case tracking an entry on one file talks of a service user being strapped into a chair the entry for 30/07/06 states, service user “leaning forward at risk of falling” the next part of the entry is not legible and then it says “was put in a chair with a safety belt”. There is no indication on file that this action was recorded as a restraint or that the procedure was discussed with anyone prior to or following the event. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 14 This issue was discussed at the inspection with the homes manager who said the incident would be fully investigated under the homes adult protection procedures. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 15 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 the following standard(s): Standards 19, 23, 24 and 26 were assessed at this inspection. Quality in this outcome area is good. This home is comfortably furnished and well maintained. The home is kept clean and hygienic, providing a pleasant environment for service users. 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 and offers a range of communal and private space. All service users rooms have appropriate soft furnishings and evidence was seen of service users own personal belongings such as some of their own furniture, paintings and photographs. Service users who spoke to the inspectors said that they thought their rooms were very nice. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. Staffing levels in the home are appropriate. Members of staff have a range of skills and appear competent to meet the needs of the service user group. Service users are protected by the homes recruitment procedures. The home has a training programme, which reflect the needs of the service users. EVIDENCE: The number and skill mix of staff on each floor was appropriate on the day of inspection. Five staff files were inspected and these demonstrated that the home follows a thorough recruitment process. Files held two written references, and evidence of satisfactory checks, Criminal Records Bureau Disclosures (CRB) are kept separately in a locked filing cabinet. The Inspector was informed that 20 members of care staff are qualified to the level of NVQ 2 or above and a further 17 members of staff are undertaking the course at present. This information was clarified in the pre inspection questionnaire. Over 50 of care staff are now qualified to the level of NVQ 2.. Training has in the past been co-ordinated centrally by Care UK. Responsibility for staff training has now been taken over by the manager at Muriel Street. The training plan showed evidence that a range of training has been undertaken including COSSH training, moving and handling and POVA training. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 17 From observation of practice and discussion with staff and residents it was evident that members of staff working on the day of the inspection are aware of the needs of service users and are able to carry out the work in a competent manner. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 were assessed at this inspection. Quality in this outcome area is adequate. The homes Manager is registered with the Commission for Social Care Inspection. The staff team in this home appear to be settled and service users benefit from this. An appointed person, often a family member, looks after the financial interests of each service user. Supervision and appraisal of staff is not taking place regularly. In general the health and safety of staff and service users is protected by the homes policies and procedures. EVIDENCE: The Manager of this home is registered with the Commission for Social Care Inspection. The registration certificate and insurance information can be seen in the reception area of the home. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 19 It was evident from observation that service users, were being supported by a staff group, who knew them and offer consistent care. One service user told the inspector that there is always someone to talk to and you can always find a member of staff if you need something. The financial procedures of the home show that each service user has an appointed person to help them with their finances this is usually a member of the family or a member of the care management team in Islington. The staff and management of the home do not act as an appointee for any service users at the home. Two service users manage their own financial affairs. Staff files on each of the three floors were seen and these showed that supervisions and appraisals do not take place. None of the files included an appraisal and only one file seen showed that one supervision had taken place in the past year. All care staff should have at least six recorded supervision sessions each year and an annual appraisal. Evidence also showed that team meetings were not held regularly. One team meeting took place in October 2005 another in April 2006 a meeting was due to take place in July but was cancelled. The homes maintenance records show the gas, water and electric installation has been checked recently and certificates have been issued. The local fire alarm tests are carried out weekly and the last fire drill was dated 22/03/06. The recording of the last three fire drills were of concern, one fire drill recorded that the response was poor but there was no evidence to show this had been reviewed. Fire drills are recorded on the weekly test records and only say that they happen there is no information regarding how long it has taken to vacate the building or what, if any problems arise. Issues regarding the recording of fire drills must be addressed and must include the date and time of the drill any problems that arise and what action will be taken. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 20 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X 3 3 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 3 X 3 1 X 2 Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 15(1)(2) schedule (3) 12(4)(b) Requirement The Registered Person must ensure that all care plans are kept up to date and reflect the needs and wishes of each individual service user. If a service user is unable to communicate verbally the method used to conduct the assessment must be explained on the care plan. The Registered Person must ensure service users plans contain evidence of preferred activities, and activities undertaken. The Registered Person must ensure a menu plan is available each day, which clearly indicates the choices of food available for each meal. The Registered Person must ensure that issued raised during the inspection regarding the care of one service user are fully investigated. The Registered Person must ensure that all care staff have at least six recorded supervision sessions each year. DS0000054457.V287250.R01.S.doc Timescale for action 31/10/06 2 OP12 16(2)(m) (n) 31/10/06 3 OP15 16(2)(i) Schedule 4 (13) 13(6)(7)( 8) Schedule 4(3)(p) 18(2) 31/10/06 4 OP18 30/09/06 5 OP36 31/10/06 Muriel Street Resource Centre Version 5.2 Page 22 6 OP36 18(2) 7 OP38 23 (4) (ae) The Registered Person must ensure that all care staff have an appraisal, which is reviewed each year. The Registered Person must ensure that fire drills are accurately recorded with time scales for evacuation, details of any issues arising and actions taken. 31/10/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 OP7 2 OP36 Refer to Standard Good Practice Recommendations It is recommended that the Registered Person ensure that all care plans follow the same general format unless an alternative format is clearly stated on the file. It is recommended that staff meetings take place at regular intervals. Staff meetings should be recorded with actions and outcomes. Muriel Street Resource Centre DS0000054457.V287250.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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