Inspection on 17/01/06 for Natalie House

This inspection was carried out on 17th January 2006.

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 found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Natalie House 29/09/08

Natalie House 27/04/06

Similar services:

Flint House

The Ley Community

Yeldall Manor

Cherwood House Care Centre

The Manor Clinic

Francis House

1 Butler`s Drive

Stoneleigh

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

CARE HOME ADULTS 18-65 Natalie House 34 - 36 St Marys Road St Marys Southampton Hampshire SO14 0BG Lead Inspector Liz Normanton Unannounced Inspection 17th January 2006 09:30 Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 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 Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Natalie House Address 34 - 36 St Marys Road St Marys Southampton Hampshire SO14 0BG 023 8022 0580 023 8022 0580 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) Home Group Limited Care Home 10 Category(ies) of Past or present alcohol dependence (10), Past or registration, with number present drug dependence (10), Mental disorder, of places excluding learning disability or dementia (10) Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Natalie House is a ten-bedded unit, which provides accommodation to single men and women with enduring mental health problems. Support is provided 24 hours a day throughout the week. Accommodation at the project is provided in two houses, which have been knocked through into one. The home has three floors, lower ground, ground and first floor. The entrance to the property has a flight of stairs. There is no provision for disability access. There are ten bed-sits, a communal kitchen/dining room, two lounges and a meeting room. Outside there is a large enclosed garden to the rear of the property. All bed-sits are fitted with en-suites. There is a smoking room for those who wish to smoke. Specialist support is available from Southampton Mental Health services. The home is situated on the outskirts of Southampton in an area called St. Mary’s which is a residential area and is close to local shops and amenities and a short bus ride to the centre of Southampton. Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of this new service. The inspection was unannounced and took place on 17/01/06. The inspector gathered information from reading policies and procedures, staff files, service user files, observation and discussion with the acting manager, care workers and a service user. The project is currently being managed by an agency worker who has been temporarily employed on a three month contract. The inspector found the manager to have the necessary knowledge and experience to manage the service. They had identified areas that were in need of improvement and were implementing change. The inspector noted from reading staff files, and discussion with care workers, that the previous manager had left a legacy of discrepancies with regard to staff recruitment, supervision and induction training. The acting manager had realised that the induction had ceased and that supervision had not been done. They had not focussed their attention on staff files, however when the inspector pointed out the recruitment concerns the acting manager took this on board and said that they would attend to the matter immediately. The care workers on duty in the morning were observed in positive interaction with the service users. Service users were able to come and go from the office and knocked first to respect privacy. One service user did barge in to the office and was obviously highly agitated and was shouting at care workers and the manager. This incident was dealt with swiftly and calmly by the manager, who asked the service user to leave the office, to go somewhere privately to be listened to. Service users were observed coming into the office to ask for their morning medication, which was given on request, and the administration was observed by care workers. Service users were offered the opportunity to speak with the inspector, however three declined. One service user stated that they had settled well at the project and enjoyed living there. There had been an incident at the project the previous night, which led to one service user being evicted with immediate effect. In discussion with the acting manager about the decision to evict a service user, it was evident that the manager was not happy in having to do this as he was aware of the service user’s mental health needs, however due to the nature of what happened there was no alternative. Overall the project is supporting individuals with enduring mental health problems very well with only four requirements being made. The communal accommodation provides comfortable relaxing surroundings in which service users can choose to spend their time. A comment card was received from one of the service users which gave positive feedback about the project. What the service does well: The project offers support care to individuals with enduring mental health problems and does this well. Positive relationships are building between the care workers and the service users. Service users are encouraged to undertake as much for themselves as possible with regard to their own Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 6 personal welfare, making choices, managing finances etc. The project offers outside specialist support from the mental health services. The service users needs are understood and catered for within the staff team. There is CCTV cameras installed throughout the building to monitor service users’ safety and welfare. The communal areas are tastefully decorated with calming colours and soft furnishings, which are modern and provide a comfortable environment for the service users. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 and 5 The service users were admitted directly from hospital and a number of professional meetings were held with the hospital staff, service users and the then project manager to ascertain whether the project could meet individuals’ needs. The project is able to meet the needs and aspirations of the service users. The service users were offered trial visits prior to moving into the project. All the service users all had an individual contract and terms and conditions of the placement. EVIDENCE: In discussion with the acting manager it transpired that no written needs assessments were undertaken prior to admission. He understood that the previous manager had been in consultation with care managers and hospital personnel prior to the service users being admitted to the project. Specialist services are provided by way of support from community psychiatric nurses, care managers and outreach nurses. The acting manager is hoping to introduce activities for service users such as cooking groups, visits to the cinema, lunch out etc on a one to one with support workers. The acting manager explained one service user was not happy with the food being provided at teatime and has requested that the project buy him ready meals which can be heated in a microwave. This request has been met. The inspector observed the care workers positively interacting with the service users and were calm and relaxed in their approach. Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 9 One service user confirmed that they had been to visit the project on several occasions and had chosen their bedroom and been fully involved in choosing the colour of the walls, the carpet and curtains in the room. The inspector found three service users’ files to contain a license agreement and a Stonham Support Contract. The service users had signed the contracts. One service user confirmed that they were aware of the contract and that it contained details of how to make a complaint. Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7and 8 Service users are aware of their care plans and encouraged to participate in reviewing these to ensure that their needs and aspirations are being met. Service users have full autonomy and are able to make day-to-day decisions. The service users have been offered opportunities to be involved in all aspects of the running of the project but declined to attend a resident meeting. EVIDENCE: The inspector viewed three service users’ files and found them to contain a comprehensive care plan, which covered the following areas: drug misuse, violence and aggression, mental health, offending behaviour, physical health, personal hygiene, employment training and education, independent living skills, skills for life, goals and interests and eating and drinking. The project has a key worker system. The acting manager and key workers, to make them easier to read, are currently reviewing the care plan files. One service user confirmed that they knew they had a care plan and had been involved in it being written. The acting manager stated that they try to encourage service users to be actively involved in reviewing the care plan. Two service users were asked by a care worker if they would like to speak with the inspector about living at the project but they chose not to. One service Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 11 user confirmed that they are allowed to make everyday decisions about their life. Service users were, observed by the inspector coming and going from the project as they pleased. In discussion with the acting manager the inspector was advised that a residents’ meeting had been arranged on 04/01/06 and that posters had been displayed around the home and people had been reminded. No service users attended the meeting. One service user stated that they did not know about the meeting. Policies and procedures are written in plain English and would be understandable to service users. Two service users are aware of the right to complain and have done so directly to the acting manager. The home has corporate policies and procedures in place, which in the inspector’s opinion reduces the implementation of service users’ views. As this is a new service there has not yet been a quality assurance survey. Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above standards were not audited at this inspection. EVIDENCE: Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Personal support is provided by way of help with finances, i.e. budgeting, banking etc and support to keep rooms clean and tidy, as all service users are capable of meeting their own personal care needs. Service users have selfautonomy and take care of their own health needs, care workers support them at times when they may be experiencing difficulty to manage without support. At present the service users come to the office for their medication, however the acting manager has plans for service users to have control of their medication in future following a risk assessment. EVIDENCE: One service user confirmed that they have full autonomy within the project. They can choose when to come home or stay out, the times they get up and go to bed, manage their own money, buy clothes, can make own meals at breakfast and lunch and verbally contribute to what is on the teatime menu. Service users are responsible for maintaining the cleanliness of their own room and are prompted by care workers to keep on top of this as a basic life skill. Two service users have twice weekly assistance from care workers. Service users’ health care needs are recorded as part of their care plan. There was evidence in service users’ files, which showed that they are supported by the mental health service. A service user review meeting took place on the morning of the inspection. Care workers stated that outreach care is provided as required. Service users choose to attend outside resources for support such Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 14 as the alcohol/substance misuse day centre. One serive user’s mental health had deteriorated and they had been re-admitted to the hospital. The welfare needs of the service users are understood by the care workers. In discussion with the acting manager they propose to introduce a meaningful daily activities programme, in consultation with individual service users, to enable them to have positive alternative experiences throughout the day to try to encourage them to move away from alcohol/substance misuse. Medication is stored in a locked cabinet in the office. Service users were observed coming to the office to take their medication. Care workers observe the service users taking their medication and sign to say that the service user administered their medication. Some service users’ signatures were seen on the medication record sheets, some refuse to sign. Each resident has an individual medication record sheet, these indicated the time the medication should be taken and the amount of medication, but there was no running record of how many tablets a service user had left, which made it difficult for the inspector to measure the amount of medication against the record sheets. There was a separate record of medication coming into the home. There were several types of medication system, with some tablets being in individual blister packs and others being in bottles. The acting manager is trying to introduce a new system which is the dosage of all medication required being made up into a daily dosage system on a weekly basis. This system was also present in the medication cupboard. The project had the Stonham policy and procedures medication/administration policy in place and was available for care workers to read. There was a separate lockable cupboard for the storage of controlled drugs. This was being used to store PRN medication and the manager and care workers were told to remove this. The manager stated that there are no controlled drugs at the project. Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The project endeavours to ensure that the service users are protected from abuse, neglect and self-harm. EVIDENCE: Stonham provides the project with a policy and procedure for adult protection. There is also a copy of the Hampshire County Council Social Services Adult protection policies and procedures. The home has a confidentiality reporting policy, (“whistle blowing”). Care workers who spoke with the inspector were aware of the “whistle blowing” policy and procedure. There have been incidences at the project, which have led to service users having made allegations against another service user. The manager has followed the adult protection procedures and informed CSCI by way of sending Regulation 37 reports of incidences, which have an adverse effect on the service users. A service user who broke the terms and conditions of the tenancy was evicted on the day of the inspection. In discussion with the manager about keeping service users money safe they stated that service users are free to keep their own finances and that the project offers them a safe place in the office to have their money held if they so wish. Two service users have appointees, which are family members. One service user who spoke with the inspector stated that they managed their own money. Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above standards were not audited at this inspection. The project was opened in September 2005 and the inspector undertook a full tour of the property prior to its opening to ensure that it was fit for purpose, and all of the above standards were met. EVIDENCE: Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35 and 36 Care workers were clear about their roles and the service users benefit from this. This is a new service with a team which is still forming, and under the circumstances the service users are being well supported by the care workers. The recruitment practices show that a number of care workers have been employed prior to all necessary checks having been undertaken to ensure that they are safe to work with vulnerable adults. Care workers had begun an initial induction training programme, which due to organisational re-structure has come to an end prior to staff having completed the induction training. The induction training was not supervised by the previous manager. There has been no formal staff supervision since the home opened in September. EVIDENCE: Care workers confirmed that they had received job descriptions and a General Social Care Council code of conduct. The project has a handover book, and care workers coming on duty read this and communicate with staff going off duty. There is written guidance of shift responsibilities, weekly and daily checks and support plans for service users. Six full time care workers are employed at the project and there is a vacancy for two part timers. Vacant post hours are covered by the existing team or by agency workers. The inspector viewed the staff rota and found that the usual shift pattern is to have two staff on duty 24/7. On a Wednesday and Thursday there are often three care workers on duty. The time between 11.00 am and Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 18 6.00 pm is for care workers to support service users on a one to one to access structured activities and outings. At night there is a sleep-in and waking night staff. The inspector viewed four care workers’ files and found only one to contain all the necessary information as required in schedule 2 of The Care Homes Regulations. One file did not contain evidence of a Criminal Record Bureau (CRB) Check or Protection of Vulnerable Adult (POVA) check and no identification, one had a CRB Disclosure, which had been transferred, and no POVA and only one reference and identification. One contained identification, a transferred CRB, references which were not dated and no POVA first check. Care workers confirmed that they had initially begun an induction training programme, which had involved going to Basingstoke for training re: company policies and procedures, health and safety, and confidentiality/communication. The acting manager stated that they had yet looked at staff files and that they would make this a priority due to the inspector’s findings. The inspector saw evidence that Stonham has an induction programme which met with TOPPS standards, however this was not being monitored or assessed to ensure that the care workers were learning what they had been taught. One care worker produced their induction training pack, which had contents to evidence that the Stonam induction programme was twenty-six weeks. Care workers stated that the training had stopped. None of the care workers have been trained in basic food hygiene and are responsible for food preparation. The inspector examined three staff files and found that they did not contain records of supervision notes. Care workers confirmed that they had not been in receipt of formal supervision since taking up their employment. Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 The project is being well managed and service users are benefiting from this. EVIDENCE: The acting manager is a qualified Registered Mental Health Nurse. They have many years’ experience in the field of mental health and have had previous managerial experience. In discussion with the manager it was apparent that they have the competency to identify areas where change is required and have begun to implement change. They are also aware of policies and procedures and ensure that staff know how to implement these. Each service user living at the project has a contract. Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 3 32 x 33 3 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 x x x x x x Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NA 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 YA2 Regulation 14 Requirement A needs assessment must be undertaken prior to admission to ensure that the project can meet the needs of the service user. Staff files must contain evidence as required under schedule 2 All staff must have a structured induction that meets with training requirements. Timescale for action 30/04/06 2 3 YA34 YA35 19 Sch 2 18 (c ) (i) 30/04/06 30/04/06 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 Refer to Standard YA20 Good Practice Recommendations Consideration should be given to the medication recording system as it appeared chaotic with lots of documentation. Because of this the inspector was unable to count medication to ensure the amount in the blister pack was in accordance with the amount recorded Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Natalie House DS0000065704.V274585.R01.S.doc Version 5.1 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!