Inspection on 31/08/06 for Nile Centre (The)

This inspection was carried out on 31st August 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nile Centre (The) 08/01/08

Nile Centre (The) 28/11/05

Nile Centre (The) 20/06/05

Nile Centre (The) 04/11/04

Nile Centre (The) 05/07/04

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

CARE HOME ADULTS 18-65 Nile Centre (The) 105-109 Foulden Road Hackney London N16 7UH Lead Inspector Sandra Jacobs-Walls Unannounced Inspection 31st August 2006 11:30 Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 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 Nile Centre (The) DS0000010278.V309616.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 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. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nile Centre (The) Address 105-109 Foulden Road Hackney London N16 7UH 020 7241 3003 020 7241 4421 allen.eno@kush.org.uk 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) Kush Housing Association Limited Mr Allan Michael Eno Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2005 Brief Description of the Service: The Nile Centre project aims to provide 24-hour crisis, outreach and therapeutic service for members of the African/Caribbean community living in Hackney experiencing mental health crisis. The project provides a preventative service, through the avoidance, where possible of longer-term hospital admissions. The Nile Centre works in partnership with existing mental health services to enable service users to manage their mental health needs. Shortterm accommodation for up to 2 weeks is available for a maximum of nine people in single rooms. Culturally reflective counselling, complementary therapy, group work, activities and support are available. Service users can make self-referrals and referrals are additionally received from health and social care agencies. The home is situated in a residential area of Stoke Newington within the London Borough of Hackney. Local shops and amenities, including a local market, are within close proximity. Bus links are good. At the time of the inspection five service users were having respite at the unit. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of The Nile Centre took place on August 31st 2006 for the duration of six hours. A senior member of staff assisted the inspector as at the time of the inspection the centre’s registered manager was on annual leave. The inspection process included the review of three service users’ files, an interview with one service user on respite at the centre at the time of the inspection, discussion with another staff member, the review of key policies and documents and the review of medication information held on one service user. The inspector would like to thank all service users and staff who co-operated and contributed to the inspection. As a result of the inspection findings six requirements and two recommendations were made. What the service does well: What has improved since the last inspection? The inspector noted that documentation of information evident on individual service user files had improved as per the recommendation of the previous inspection. In particular, the inspector noted that the documentation of general and specific discussion between staff and service users were increasingly focused on placement objectives and explored more keenly identified and developing service user need. This had not been the case at the previous inspection. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 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 Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The inspector saw good evidence via the three service users’ files reviewed of needs assessments being consistently conducted. Information available via the centre’s referral form identified basic needs at the point of referral and centre staff, as part of the admissions process, comprehensively assessed service user needs. Some files evidenced completed assessments by the referring agency. The service user who spoke with the inspector confirmed that upon each admission to the centre she participated in an assessment of her needs during an initial home visit by staff. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 9 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): 6,7 & 9 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The inspector as satisfied that service users had care plans in place; the senior member of staff present confirmed this during the inspection and files reviewed by the inspector all evidenced care plans. The service user who spoke with the inspector was able to give clear information about the contents of her care plan and confirmed that staff were assisting her address needs identified upon referral. Documentation reviewed on service user files were sufficiently comprehensive and identified well which aspect of the care plan was being addressed at any given tie., However the inspector was of the review that the tool used to record 1:1 sessions with service users was limited in providing sufficient space for staff to elaborate on discussion/key work sessions held. It is recommended that the centre’s daily recording tool be amended to allow for more comprehensive recording of discussions held with service users if necessary. The senior member of staff gave good examples of service users participating in the decision making process. So, for example self management of service users’ medication is encouraged, service users have freedom of movement Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 10 while staying at the centre and on a weekly basis make decisions about menu choices. Service users were supported to fully participate in the assessment and care planning process and in scheduled ‘midway’ review meetings. The inspector reviewed the minutes of the centre’s Residents Meetings, which were regularly convened and gave service users the opportunity to discuss and make decisions about a range of issues, largely determined by service users themselves. Files reviewed by the inspector also evidenced documented risk assessments. These assessments were conducted both by the referring agency at the point of referral and again via the centre’s internal assessment process. Most risk assessments seen were primarily focused on the risk of relapse in service users’ mental health state. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 11 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): 12,13,15,16 & 17 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The Nile Centre offers respite care to service users experiencing or developing mental health crisis. While staying at the centre service users are encouraged to participate in activities of their choice that help address/alleviate feelings of distress. Staff are at hand to explore with service users activities that may enhance this process. Service users are encouraged to continue to participate in employment, training and recreational activities if they so wish. The inspector saw on file staff helping to address the identified spiritual needs of one service user who at the time her stay was wanting to explore deeper issues of faith. The service user who spoke with the inspector described how staff had supported her to shop for clothes and enrol on a college course to pursue an art degree. Service users were encouraged to maintain contact with family members and friends, who were welcome to visit service users at the centre. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 12 The inspector reviewed the menu planner for the week of the inspection and was satisfied that meals offered were nutritionally balanced, varied and culturally appropriate for service users who were all of African or Caribbean descent. The inspector noted that the menu planner also highlighted in writing the nutritional value of meals offered. The inspector had a lunchtime meal with a service user during the inspection, which was nutritious, appetising and well presented. The service user commented that meals prepared by the centre were consistently of a very high quality. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 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 & 20 Quality in this outcome area is adequate. This judgment had been made using available evidence including a visit to this service. EVIDENCE: Due to the nature of the service, staff of The Nile Centre are generally not required to offer personal care to service users. The senior member of staff commented that moreover, service users are encouraged to maintain good personal hygiene. The inspector saw good evidence on file to support the view that service users physical and emotional health care needs were being addressed. These issues were explored via the assessment process and where necessary, featured on service user’s care plans. So, for example one service user’s care plan highlighted the service user’s desire to lose weight. Most care plans seen identified the need for service users to maintain a positive mental health state as a placement objective. The inspector reviewed the medication information for two service users in detail. The recording of service users’ medication information had been changed in line with the recommendation of the previous inspection. While documentation reflected the involvement of the Home Treatment Team as recommended, further improvement is needed to the recording of service users medication information. Specifically, the review of the medication information for one service user on MAR (Medication Action Records) was unclear as on at least three occasions there was no entry on MAR sheets to Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 14 verify whether medication had been taken or even offered. This was despite a comprehensive ‘key/coding’ system to assist staff. The senior member of staff suggested that the blank spaces on the MAR sheets indicated when medication had been withdrawn/withheld on the instructions of the Home Treatment Team. It was the inspector’s view that daily records that remain blank do not verify action taken by staff/the service user in relation to the medication regime. It is the inspector’s recommendation that the use of alphabetical key/codes to indicate action on MAR sheets are further developed so that an explanation is offered and verifies the action taken for medication dose. It is further recommended that senior staff periodically review the recordings on MAR sheets for the purpose of quality assurance. The inspector was similarly concerned to observe that the centre’s medication cabinet contained discarded service user medication for service users who had left some time ago. Discarded medication must promptly disposed. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 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): 22 & 23 Quality in this outcome area is adequate. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed information contained in the centre’s complaints book. Since the last inspection, nine complaints from service users had been documented; most of these complaints were related to the conduct of staff. The complaints book detailed the nature of the complaint and in some instances indicated what action had been taken. However, in many cases no response letters to complainants or documentation of complaint investigations could be evidenced, either in the complaints file or on individual service user files. The senior staff member commented that she was aware of complaints investigations having been conducted and outcomes having been communicated to the complainant, but in most instances, on the day of the inspection, no such evidence was produced. The service must maintain centralised records of complaints, copies of letters forwarded to complainants and documentation of any complaints investigation and their outcome. The inspector spoke with a service user who commented that she had made a formal complaint against staff members in relation to their conduct. While the complaint was subsequently found to be unsubstantiated, the service user indicated that she had been fairly satisfied with the process. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 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): 24 & 30 Quality in this outcome area is adequate. This judgment had been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection, the premises were clean and hygienic; the service user who spoke with the inspector commented that the building was usually kept very clean. The senior staff member informed the inspector that the outstanding building works, anticipated to commence at the beginning of the year was yet to start due to a number of issues, including contractual negotiations with the landlord and the relocation of staff of associated KUSH projects. It is now unclear when work to improve the premises will now begin, but the senior staff member indicated that a start date might be imminent. The outstanding requirement regarding improvement to the service’s environment is therefore repeated. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 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): 32,34 & 35 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection in November 2005, there had been a number of staff changes at the centre, four permanent members of staff had left the service. Staff said however that the impact of this had been minimal as existing agency staff adequately covered shifts. The staff team is well established and possess an array of skills and work experience and are appropriately qualified, including NVQ awards. Staff personnel records of the entire staff group had been reviewed during the previous inspection, all staff information as required had been evidenced. The senior member of staff commented that since that time only one member of staff had been recruited and she was satisfied that all necessary checks were in place. Staff records were therefore not reviewed during this inspection. Staff interviewed commented that they felt well supported by the centre’s management team and indicated that they felt the service continued to develop positively. A number of agency workers were considering securing employment contracts with the provider. Staff training opportunities were good, staff confirmed that they had participated in training focused on managing challenging behaviour, mental health awareness, food hygiene, and HIV awareness to identify a few. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 18 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, 39 & 42 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: Staff and service users who spoke with the inspector indicated that they felt the service was well run. The service user indicated that she felt service provision had improved over the past year and that good attention was being paid to addressing her needs. Staff who spoke with the inspector indicated that they felt well supported by the centre’s management team and that the registered manager and senior staff worked effectively together. The registered manager is continuing to complete the required management training, (The Registered Manager’s Award) and so the related requirement remains in place. The inspector was informed that the care provider, KUSH Housing had recently merged with another independent provider, (Places for People). The impact of the merger on the service was said to be minimal, although as a result, the former Chief Executive/ Responsible Individual had left the KUSH organisation. Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 19 The service will need to identify appropriate personnel to be registered with CSCI as the Responsible Individual a matter of priority. The inspector saw documented evidence of monthly unannounced monitoring visits being conducted and was satisfied that subsequent reports were made available to staff to action. Overall, the inspector was satisfied that the health, safety and welfare of service users were protected and promoted. Nile Centre (The) DS0000010278.V309616.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 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 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 x Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The registered manager must ensure that recordings on MAR sheets are accurately completed and that keys are used consistently to confirm action. The registered manager must ensure that all discarded service user medication is promptly disposed. The registered manager must ensure that centralised records of complaints are maintained which include evidence of action taken and the outcomes of any complaint investigation. The registered manager must ensure that outstanding building works and re-decoration of the premises are completed. (Previous timescale 31/08/06 not met) The registered manager must ensure that he complete the required management training. An application must be submitted to CSCI for the register of the Responsible Individual. Timescale for action 31/10/06 2. YA20 13(2) 31/10/06 3. YA22 22 31/10/06 4. YA24 23 31/12/06 5. 6. YA37 YA43 19(5)(b) 7 31/12/06 31/10/06 Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 22 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 YA6 Good Practice Recommendations It is recommended that the service’s daily recording tool be amended to allow for more comprehensive documentation of discussions with service users if necessary. It is recommended that senior staff of the service periodically review MAR to help minimise recording errors. 2. YA20 Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection East London Area Office Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU 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 Nile Centre (The) DS0000010278.V309616.R01.S.doc Version 5.2 Page 24 - 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!