Inspection on 08/01/08 for Nile Centre (The)

This inspection was carried out on 8th January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nile Centre (The) 31/08/06

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 Adrian Gordon Unannounced Inspection 8 January 2008 11:00 th Nile Centre (The) DS0000010278.V355707.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.V355707.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.V355707.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 vacant post Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st August 2006 Brief Description of the Service: The Nile Centre project provides a 24-hour crisis, outreach and therapeutic service for members of the African/Caribbean community living in Hackney experiencing mental health crisis. Short-term accommodation for up to 2 weeks is available for a maximum of nine people in single rooms. The Centre 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. Information about the service is available in the Statement of Purpose and Service User Guide. There are no fees for people to use the service. Referrals are made through a relevant professional or by self-referral. Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over five hours by two inspectors. It consisted of a tour of the premises, observation of practice and examination of records. We spoke to people who use the service, staff on duty and the Community Service Manager. Completed surveys were received from seven staff and two people that use the service. The home completed an Annual Quality Assurance Assessment (AQAA) to tell us about the service provided, how it makes sure of good outcomes for the people using it and any future developments being planned. What the service does well: What has improved since the last inspection? What they could do better: In order to better protect staff and individuals, risk assessments must be more detailed and kept up to date. There must be a clear audit of medication coming into and leaving the Centre. Staff must receive training in the administration of medication. Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 Page 6 To improve the environment, the outstanding building works and redecoration must be completed. So that staff have the necessary support to carry out their roles, training plans must be kept up to date and core training provided. A registered manager must be appointed to the service. To make sure there is effective monitoring, monthly visits by the provider must take place, and a report of each visit be kept on the premises. Staff must be made aware of the issues the CSCI should be notified of to comply with the Care Homes Regulations. To make sure all parts of the service are safe, a fire risk assessment must be in place. 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. Nile Centre (The) DS0000010278.V355707.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.V355707.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the service takes place once they are confident they can meet the assessed needs of individuals. EVIDENCE: The case records for four people who use the service were looked at during the inspection. Assessments are carried out before people are admitted. The detail of information varied depending on the reason for the admission, however it was sufficient for centre staff to meet individual needs. The centre has a referral form which identifies basic needs. Some people come with more detailed assessments from the agency which referred them. Agreements between the service and new referrals are completed on admission. These include rules and expectations during their stay and are signed and dated. Nile Centre (The) DS0000010278.V355707.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are involved in making decisions about how their needs can be met by the service. Risk assessments do not provide sufficient detail to fully protect staff and individuals. EVIDENCE: Files contained care plans for each person that uses the service. The detail of each plan varies depending on the reason for admission. Two files had a Crisis Intervention Plan which highlights needs such as housing and health, together with the intervention required and who needs to carry it out. Mid stay reviews take place to monitor the placement and make any changes to the care plan if needed. People who use the service are involved in care planning meetings and reviews. They are encouraged to make decisions about what they do each day, particularly in relation to the goals in their care plan. Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 Page 10 Risk assessments are in place but are very basic and lacking in detail. One risk assessment had not been updated at the beginning of a person’s most recent stay. Daily notes show that occasionally staff are threatened with aggressive behaviour by people who use the service. However, there were no risk assessments to explain the triggers of behaviour or the action to take in the event of being harassed or threatened. Nile Centre (The) DS0000010278.V355707.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to take part in activities of their choice and are supported to take responsibility for their daily lives. EVIDENCE: There is a plan of suggested activities for the week which includes group discussion, creative writing and games. These are flexible and organised each day if people who use the service want to take part in them. Staff said that it is easier to get interest in activities when the service is full rather than when only one or two people are living there. Individuals are encouraged to be independent and to carry on with their usual routines in the community. Support is given to help with employment or adult education if this is needed. There is information in the lounge about Lee House, Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 Page 12 which is a local Employment and Rehabilitation Centre. This provides activities and training such as gardening, yoga and computer skills. People who use the service are encouraged to maintain contact with family and friends. There is a sexuality and relationship policy which is discussed on admission and in resident meetings. A varied menu shows a good range of food which reflects people’s cultural background. This included curried goat and chicken with rice and peas. People who use the service are involved in planning the menu and sometimes assist with preparation of meals. Comments from individuals were very positive and included ‘the food is very good’ and ‘why would I want an alternative?’. Nile Centre (The) DS0000010278.V355707.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Good support is available to meet the health needs of individuals. The system for monitoring medication is not effective at preventing errors. EVIDENCE: Assessments of people who use the service include any relevant information about health and personal support. Staff said that the service is closely involved with the local health services and the Community Mental Health Team. On admission the care plan will include details of any support needed to access health resources if necessary. A professional reflexologist visits every week and a counsellor is also available for support if needed. The majority of people self administer their medication. Assessments are completed to ensure that they are able to do this safely. Staff administer medication if required and Medication Administration Records are maintained and signed. One person’s medication was counted and found to be missing one tablet. This must be investigated and a report sent to the CSCI. Records are not kept of medication received by or leaving the service. This does not allow a Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 Page 14 clear audit trail. Staff have not received recent training in medication administration. This must be provided. Nile Centre (The) DS0000010278.V355707.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some individuals say they know how to make a complaint but others do not. Complaints are recorded but outcomes and actions are not properly logged. EVIDENCE: The service has developed a complaints procedure which is available to people who use the service. In questionnaires received from two people, one person said they knew how to complain while the other person said they did not. The service must make it clear on admission how people can complain. There have been three complaints since the last inspection. Records show that two complaints have been investigated and included a copy of a letter from the home either apologising or explaining the reason for the issue. Neither of these complaints showed whether the complainant was satisfied with the outcome. Staff confirmed they have been trained in the protection of vulnerable adults. Information on abuse and whistleblowing is displayed in the dining area. Nile Centre (The) DS0000010278.V355707.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The continued delay in redecoration and refurbishment means that people who use the service continue to live in an environment which needs improvement. EVIDENCE: The service currently has a confusing layout with many doors, corridors and stairwells over different floors. The building work which has been highlighted in previous reports remains outstanding. The Community Services Manager explained that there were still contractual negotiations taking place in relation to this. However, it was confirmed that a complete refurbishment will take place in the near future. This will include new carpets and repainting of walls which will make a big improvement to the environment. Most parts of the premises were clean and tidy. A communal lounge and dining area was comfortably furnished and provided access to the main kitchen. Some of the toilets and bathrooms were very basic and needed cleaning. Nile Centre (The) DS0000010278.V355707.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from having a competent staff group to support them. Staff training plans are not kept up to date which means that they may not be getting the training they need. EVIDENCE: Staff had a good understanding of the needs of each person that use the service. It was clear that staff see the work they do as providing valuable support to those that need it. There was a good atmosphere in the establishment and staff were seen to relate well with the individuals there on the day of inspection. The rota was examined but did not accurately reflect what staff were on duty. For example, the rota did not note that the deputy was on annual leave and had not been updated to include the staff on duty on the morning of the visit. The main staff recruitment files are kept at the Head Office and were not looked at during this inspection. However, staff files had evidence of some of Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 Page 18 the recruitment checks such as application form, proof of identification and Criminal Records Bureau check. The Community Service Manager was advised to keep a record in the Centre showing confirmation of all necessary recruitment checks. Training needs are discussed in staff supervisions. Training records are not kept up to date so it was difficult to assess which training had taken place recently. Staff said that they had received recent training in the protection of vulnerable adults, food hygiene, first aid and mental capacity awareness. There has been no recent training in medication. Two staff said that they receive appropriate training and supervision to carry out their roles. Records indicate that one member of staff had not had supervision since July 2007, however the majority of staff were being supervised regularly. Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is no registered manager in place which means that the monitoring of health and safety systems is not fully effective. EVIDENCE: There is currently no registered manager in post, but an advert is out to recruit to this position. The deputy manager and Community Service Manager are covering until the vacancy is filled. The lack of a manager has meant that some of the systems in the service have become inconsistent. For example, rotas are not clear, records are difficult to find, and there is difficulty in accessing some offices. Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 Page 20 People who use the service are asked to fill out a satisfaction survey after their stay. Staff reported that completed forms are seen by the seniors and any changes, actions or concerns are raised through staff meetings. It may be better to compile the responses and use them to acknowledge changes to the service in a report. The record of monthly monitoring visits only had reports from October 2007 for the last year. It was unclear whether these visits are happening every month. Health and safety checks are not always happening on time. An overdue Portable Appliance Test is now planned for later in January 2008. Fire drills take place regularly and there are weekly fire point tests. A visit by the London Fire and Emergency Planning Authority (LFEPA) in April 2007 highlighted some serious concerns including the lack of a fire risk assessment. A return visit by LFEPA due for July 2007 did not take place. Since this inspection the Community Service Manager has been chasing this up. Health and safety issues are discussed in resident meetings. Minutes from a recent meeting show that concerns were raised about a lack of hot water of the Christmas period. The CSCI was not notified of this incident. Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 Page 21 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 3 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 2 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 X Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 12(1), 13(4) Requirement Timescale for action 01/03/08 2 YA20 13(2), 18(1)(c) 3 YA22 22 4 YA24 YA27 YA30 23 In order to ensure that staff and people who use the service are kept safe, risk assessments must be more detailed and include any risk of threatening behaviour. To prevent the risk of medication 01/03/08 errors, a clear audit trail of medication entering and leaving the home must be in place. Staff must receive recognised training in the administration of medication. The missing tablet must be investigated and a report sent to the CSCI. So that people who use the 01/03/08 service feel they are listened to, they must be told how to complain and any complaints must be recorded and investigated fully, including an outcome for the complainant. To improve the comfort of the 01/04/08 service, the outstanding building works and re-decoration of the premises must be completed. (Previous timescale 31/08/06 & 31/12/06 and 30/06/07 not met) Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 Page 23 5 YA33 6 YA35 18(1)(a) 18(c) 7 YA37 8 8 YA39 26 9 YA42 37 10 YA42 13(4) So that staff are clear about when they are working and who is on duty, the rota must be kept up to date and accurate. So that staff have the support they need to carry out their roles, core training must be provided and training plans must be kept up to date. A manager must be appointed to the home and subsequently submit an application to CSCI to become the registered manager. (Previous timescale 01/05/07 not met) To ensure that there is effective monitoring of the service, monthly visits by the provider must take place and a report be kept at the Centre. The CSCI must be informed of all modifiable events as outlined in the Care Homes Regulations (Previous timescale 01/04/07 not met) To make sure that all parts of the service are safe, a fire risk assessment must be in place. The overdue visit by LFEPA must be rearranged. 01/03/08 01/04/08 01/04/08 01/03/08 01/03/08 01/03/08 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 Nile Centre (The) DS0000010278.V355707.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Nile Centre (The) DS0000010278.V355707.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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