Inspection on 15/06/06 for St George`s House

This inspection was carried out on 15th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St George`s House 16/12/05

St George`s House 07/11/05

St George`s House 18/03/05

St George`s House 04/08/04

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

CARE HOME ADULTS 18-65 St George`s House 263 Camden Road Tufnell Park London N7 0HS Lead Inspector Ms Jill Marriott Unannounced Inspection 15th June 2006 10:00 St George`s House DS0000020978.V287253.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 St George`s House DS0000020978.V287253.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. St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St George`s House Address 263 Camden Road Tufnell Park London N7 0HS 020 7607 7989 0207 371 7519 stg@2care-rsl.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) 2 Care Miss Bettina Jeppesen Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23) of places St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Home for up to 23 adults (men and women) aged under 65 with needs relating to mental health 16/12/05 Date of last inspection Brief Description of the Service: St George’s House is registered with the Commission for Social Care Inspection as a care home for 23 adults between the ages of 18 - 65. It is a mental health project owned and managed by “2Care”, a Registered Charity. The homes focus is on providing rehabilitation for adults recovering from mental health problems. St George’s has been open since 1989. The Rehabilitation service is designed to enable individuals to acquire or regain the skills necessary to live as independently as possible. Weekly charges for services are approximately £894 per week. The home has a registered manager and a staff team providing 24-hour support 7 days a week. The building is purpose built over three floors, most of the accommodation being on the upper two floors. The general office, communal areas, kitchen and single flats are on the ground floor. St George’s is set in its own grounds, which include a small garden area and some car parking at the rear of the house. The property is in a residential area off, of a main road half way between Holloway Road and Camden. There are Over ground and Underground stations, shopping areas and a number of bus routes close by. St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first statutory inspection for 2006/7. The inspection was unannounced and lasted for seven hours over one day. The, inspector was assisted throughout most of the day by the homes manager Bettina Jeppersen who is registered with the Commission for Social Care Inspection. 26 standards were assessed during the inspection, 22 standards were met, 3 standards exceeded the national minimum requirements and 4 standards were partially met. The inspector toured the building examined records and spoke with 2 service users and 3 members of staff. The inspector would like to thank all of the staff and service users who participated in the inspection process What the service does well: What has improved since the last inspection? What they could do better: St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 6 In general this home offers good quality mental health services to the people who live there. Requirements have been made in the following areas: a) A statement of purpose must be developed, which includes the information required in standard 1.1 regulation (4) schedule (1). b) A service user guide to the home must be developed, which includes the information required in standard 1.2 regulation (5) c) All areas of the home must be clean and hygienic at all times. d) All notifiable incidents must be sent to the Commission for Social Care Inspection. 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. St George`s House DS0000020978.V287253.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 St George`s House DS0000020978.V287253.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): Standards 1, 2,4 and 5 were assessed at this inspection. Quality in this service area is good. Service users and their social workers have the information required to make an informed choice about referral to the home EVIDENCE: The, homes statement of purpose was seen by the inspector the document does not meet the National Minimum Standard and a requirement has been made in respect of this. The home does have a service user guide, which includes a range of relevant information but not all of the information required in standard 1-2 is available. The statement of purpose and service user guide to the home must be developed to include all information require by standard 1.of the National Minimum Standards. The inspector spoke with two service users who were at home during this inspection. Service users said that they had been given a range of information prior to admission and this combined with visits to the home had been enough to form a judgement and make a decision about living at St Georges House. Four service user files were seen and these showed evidence of a clear needs assessment and care plan. Service users said they had been asked about their dietary needs, religious needs and cultural needs and this formed part of their care plan. Evidence of St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 9 this was seen on files. One service user said that if he wished to attend a church or any other religious service he was confident he would be supported to do so. Service users who spoke with the inspector confirmed that they were aware of their care plans and attended care plan review meetings. All of the service user files seen by the inspector contained service user contracts, which included details about the terms and conditions of service. The contracts included full information about fees for service and outlined clearly who was contributing to cost of the placement and how much. St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 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): Standards 6, 7 and 9 were assessed at this inspection. Quality in this service area is good The home ensures service users are able to make choices and that their needs are being met. EVIDENCE: The home has a good key working system and files showed that key workers meet with service users regularly. Evidence of key work meetings were seen on files and these were signed by the service user. Evidence on files show that care plans are reviewed three monthly or six monthly with individual service users depending on need. Records show that care plans are signed by service users if a service user doesn’t want to sign their care plan a note is made on the file regarding the reason for refusal. From discussion with service user and from reading files it is clear that service users are aware of the content of their care plans. St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 11 The aim of the service provided by St Georges House is to support service users to become more independant and eventually to enable them to live in the community. One service user told the inspector that he was involved in making decisions about his life and with his key worker is able to make decisions about how much support is needed for individual tasks, the service user told the inspector that it is alright to change your mind and talk things through again if necessary. Members of staff spoke about the planned stages that all service users work through to gain as much independaence as is possible. Risk assessments are clearly seen as an important aid to keeping service users safe in the home and in the local community. Risk assessments were seen on all four files examined and evidence showed that these are monitored regularly as part of the care plan review. Two service users who spoke with the inspector said they felt safe at St Georges House. St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 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): Standards 11, 12, 13, 14, 15, 16 and 17 were assessed at this inspection. Quality in this service area is good The home offers lifestyle choices and ensures that service users are prepared for living as independantly as possible in the community. EVIDENCE: Evidence on service users files, show that personal development forms the basis of the care plan, which is reviewed regularly. One service user told the inspector that all aspects of life had improved since coming to St Georges House especially self confidence. St Georges House is a rehabilitation service and the aim is to support service users to live independently in the community St Georges offers three stages to the rehabilitation programme stage one offers a high level of support, stage two offers semi independent living and stage three offers the service user the opportunity to live independantly in a flat attached to the project. The length of time needed for service users to reach independence is based on need and service users progress is monitored and reviewed throughout their stay at the home. St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 13 The home has vast range of activities available. Activities include discussion groups, art groups, trips to the cinema, swimming and bowling and an annual holiday. Service users said they were impressed with the activities and were included in decision making about them. One service user described a football tourmament which had taken place the previous day. This activity had been organised by service users and staff from all of the “2care” projects it had included families and friends of service users and had been very successful with St Georges winning the cup. The home has a computer room where service users can use computers or learn to use them. The computer room is very popular. St Georges also make use of community projects and service users attend day centres and community job retraining projects. Some service users do voluntary work in the community. Discussion with service users and information on files show that friends and families are welcome at the home. Service users said it is important to ensure staff know who is in the building and give 24 hours notice if anyone wants to stay over. Members of staff confirmed this but added that a risk assessment may be undertaken depending on the individual circumstances of the service users. St Georges have house rules, which are included in the service users handbook members of staff always knock before entering a service users room. The care plans on each of the files seen by the inspector show that service users are supported to make choices and be as independent as possible this is of course subject to the restrictions agreed at the planning stage and review of each placement. Service users are very much involved in choosing buying and preparing the food at the home. Unless completely self-catering all service users can access three meals a day plus drinks and snacks. Menus are planned weekly in the “food group” the dietary and cultural needs of service users are taken into account when planning the menus. Service users are supported during their stay to understand the principals of food hygiene by staff and other service users who have been resident for a longer period of time. The food on the day of the inspection looked healthy and nutritious. St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 14 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): Standards 18,19 and 20 were assessed at this inspection Quality in this service area is good There are procedures in place to meet the health and personal care needs of the service users. EVIDENCE: Discussion with service users and information on care plans seen show that personal support is offered in a sensitive way. Staff support service users throughout their stay at the home to manage their own personal health care. The project does not provide nursing care but supports service users to register with a G.P where necessary and to access local health care support, which includes dental, chiropody, optical or dietary care. Key workers also support service users to attend health appointments where appropriate. The home provides a range of advice and information about general health issues and appropriate information leaflets were seen placed around the building during the inspection. All of the staff at St Georges have received appropriate first aid training and there are first aid boxes located in the office and the kitchen area of the home. Prior to admission service users agree a medication plan with the home. Enabling them to self medicate is the key to eventual independent living and is St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 15 considered an important part of the care plan. Initially the home takes responsibility for medication and then through the process of risk assessment, monitoring and review service users are supported to take more responsibility for their medication. Information regarding medication was seen on the files tracked. The homes medication policy and procedure are appropriate. St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 16 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): Standards 22 and 23 were assessed at this inspection. Quality in this service area is good. Service users feel safe and protected by the homes policies and procedures. EVIDENCE: St Georges House has an adequate complaints procedure a copy of which is given to every service user on admission to the home. All complaints are taken seriously and are acted upon within the given time scales. One service user complaint was tract by the inspector. The complaint was written in the complaints book with actions taken and outcomes recorded. The service user told the inspector that the complaint had been handled well by the homes manager and the outcome was satisfactory. Service users are protected from abuse by the homes policies and procedures and by the homes training programme for staff. All members of staff receive induction training, which is thorough and includes issues of health and safety and adult protection. The home has a whistle blowing policy and procedure and an adult protection policy. Staff files seen evidenced relevant training including the protection of vulnerable adults (POVA) and whistle blowing procedures. Members of staff were able to explain the procedure for dealing with issues and allegations regarding adult protection. All of the policies and procedures for this home are on the homes intranet system and members of staff are kept informed of any changes or additions. Dates of appropriate training courses are also available on the intranet. St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 17 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): Standards 24 and 30 were assessed at this in inspection. The The home is made as homely as is possible. Staff and service users take responsibility for the cleanliness of the home. Some areas of cleanliness are in need of improvement. EVIDENCE: This home was at one time a hostel. It is clear from the tour of the building that every effort has been made by the manager and the staff group to make the building more, user friendly and homely. The inspector noted personal touches such as flowers in hallways and pictures on walls. The home has a five-year rolling maintenance programme, which is in progress at the present time. In general this home provides a comfortable and safe environment for service users. Service users told the inspector that their own personal space was of good quality with appropriate furnishings. Service users are responsible for keeping there own rooms clean and tidy and there is a domestic who undertakes general household cleaning duties. One of the independence training flats was seen the cooker and surrounding tiled area in this flat was very greasy and needs to be cleaned. In general the home is clean and hygienic St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 18 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): Standards 32,34 and 35 were assessed at this inspection. Quality in this service area is good Members of staff in this home are offered appropriate training. The homes recruitment policy and procedure ensure the protection of service users. EVIDENCE: The home has an appropriate recruitment policy and procedure. The inspector examined four staff files. The home keeps copies of recruitment information on the file of each member of staff. Each file seen included an up to date CRB disclosure and two satisfactory references. Information regarding the induction process and the probation period was also recorded. Files showed evidence of regular staff supervision. Service users who spoke with the inspector confirmed that they felt the staff team had the relevant experience and knowledge to support them during their placement at the home. The inspector was told that every member of staff has either received training to the level of NVQ 2 or is being trained at present. The manager is undertaking the Registered Managers Award. Evidence of NVQ training was recorded on staff files. St George`s House DS0000020978.V287253.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 were assessed at this inspection. The, home is managed to a high standard by a qualified and competent manager. Service users benefit from a competent approachable staff team. EVIDENCE: The manager of this home is registered with the Commission for Social Care Inspection and a registration certificate for the home is displayed in the entrance hall. The home also has an up to date copy of the insurance certificate on display. The inspector was told that the home has a full complement of staff at present and has just been given one extra post. Work has begun to recruit a senior mental health recovery worker. The home is staffed 24 hours each day. There are never less than three members of staff on duty at any one time plus two members of staff sleeping in. Senior on call support is also provided. Service users have recently been involved in filling out a survey/questionnaire to look at future developments at St Georges House. Service users who spoke to the inspector were confident that their views would be considered when St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 20 developing the project. The homes business plan is reviewed and developed yearly. The, Health and Safety files were seen by the inspector and these appeared up to date fire drills are held regularly at least four times each year the last fire drill was held on 13/04/06. Daily and weekly health and safety checks are carried out throughout the home and these are also recorded. The home has a COSHH procedure and all substances hazardous to health are risk assessed and kept in an appropriate locked cupboard risk assessments were reviewed in May of this year. The homes electrical certificate is dated 03/01/06 and the gas certificate 27/04/06. The inspector examined the incident and accident book. The book contained information regarding a serious incident. This incident has not been notified to the commission. A regulation 37 notification must be sent to the commission regarding all incidents identified in Regulation 37. St George`s House DS0000020978.V287253.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 2 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 22 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 YA1 Regulation 4(1)(2) schedule (1) Requirement The Registered Person must ensure that the home has a statement of purpose, which meets the requirements of standard 1. of the national minimum standards. The Registered Person must ensure that there is a service users guide, which sets out clear and accessible information for service users and includes the requirements described in standard 1. 2 of the National Minimum Standards. Timescale for action 31/07/06 2. YA1 5(1)(2) 31/07/06 3 YA30 23(2)(d) 4 YA42 37(1)© The Registered Person must 31/07/06 ensure that all areas of the home including the cooking facilities in the semi independent and independent flat are clean and hygienic at all times The Registered Person must 05/07/06 ensure that all notifiable incidents are sent to the local CSCI office as soon as possible after the event. St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 23 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 St George`s House DS0000020978.V287253.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: 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 St George`s House DS0000020978.V287253.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. 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. 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