Inspection on 07/11/05 for St George`s House

This inspection was carried out on 7th November 2005.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St George`s House 15/06/06

St George`s House 16/12/05

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 Franki Solomon Unannounced Inspection 7th November 2005 10:00 St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 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.V264221.R01.S.doc Version 5.0 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.V264221.R01.S.doc Version 5.0 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 2care@stgeorgeshouse.fsbusiness.co.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.V264221.R01.S.doc Version 5.0 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 18th March 2005. Date of last inspection Brief Description of the Service: St George’s House is a residential, mental health project owned and managed by 2Care, a Charity and Registered Social Landlord. The aim of the service is to provide short to medium term rehabilitation and to secure appropriate move-on independent accommodation. St George’s House has been open since 1989 and can provide support for up to twenty-three people who have mental health support needs (some forensic). Placements are for up to three years, although currently there are people who have been there for longer. The building is a purpose built establishment over three floors, most of the accommodation being on the upper two floors. The general office, communal areas, kitchen, and cluster flats are on the ground floor. The home has a registered manager and a staff team providing 24-hour/7 day support. The property is off a main road halfway between Holloway Road and Camden Overground and Underground stations. There are good bus routes in each direction. St George’s House has limited private parking. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first statutory inspection of the year April 2005 – March 2006. The inspection was unannounced. The inspection was over one day lasing 7 hours. The inspector was accompanied by the Registered Manager. The inspection covered key standards and was to talk with service users, staff and discuss with the manager, also to examine documents and files and a tour of the building. The inspector would like to thank service users, staff and the manager for their co-operation. What the service does well: What has improved since the last inspection? The Home is responsive to requirements made by the Commission following inspections. Despite the layout of the home, efforts are made to make the Home homely. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 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. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 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.V264221.R01.S.doc Version 5.0 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): 1 & 2. St George’s House does not have a Statement of Purpose or Service User Guide to meet the requirements of the National Minimum Standards Act 2000 and its regulations. St George’s House ensures service users have a good assessment to enable them to make an informed decision. EVIDENCE: The home has a comprehensive Handbook which is useful to service users. However, it does not have a Statement of Purpose nor a Service User Guide which sets out information required under the Care Standards Act 2000. This was discussed with the manager who has agreed to compile the two documents as required. A requirement has been made. St George’s House has a pre-assessment interview with prospective service users. The interview takes place with the service user and their care manager. A full assessment is undertaken by St George’s by appropriately qualified persons to ensure that both the service user and St George’s will be an appropriate placement. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 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. The home’s robust key-working system and the consultation with service user over their Care Plan ensures service users are constantly aware of their Care Plan. The ethos of the home is to involve, and for service users to participate in everyday tasks. Risk assessments are robust and are also formulated so as to enable service users to develop independence as appropriate. EVIDENCE: All arrangements were in place in terms of service user’s care plans and risk assessments. In discussion with the manager, service users and the examination of care plans it was evident that the Home works with service user on a keyworker basis, that service users sign off their care plan and records have indicated where service users have refused to sign their care plan. A recommendation has been made. From the initial point of placement, it was evident that the home works consistently through a system of stages with service users to enable them to make appropriate decisions. The aim of the home is for service users to finally move on and live independently. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 Page 10 The Home has robust Risk Assessment policies and procedures for service users which are clearly followed through in the care plans. The inspector noted there was no emergency call button for staff in the office where staff could be working alone and might need assistance from staff in another part of the building. This was discussed with the manager. A recommendation has been made in terms of robust risk assessments for staff. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 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. The Home’s programme is focussed on opportunities and personal development for service users. Activities and community involvement is encouraged. Wherever appropriate service users are enabled to be part of the community and their family. St Georges ensures service users are well prepared for an independent life. EVIDENCE: Arrangements for the personal development of service users were in place. In discussion with the manager, service users and examination of care plans it was evident the home has a programme of rehabilitation which works towards enabling service users to become independent. To have full involvement with the community, family & friends and partake in activities of their choice. The nature of service users’ diagnosis does not always permit full-time employment, but they do undertake voluntary work as appropriate. Their care plan and programme is such that service users develop daily living skills to become independent and move on. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 Page 12 It should be noted however that although the Home aims for a stay of up to three years, currently there is a service user whose stay has exceeded this period of time. The Home may consider the issues that could arise for the service user when such long terms stays continue indefinitely. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 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. Service users at St George’s House are able to undertake personal care for themselves. Medication procedures are followed. EVIDENCE: Service Users who come to St George’s generally do not require support for physical needs. However, all arrangements were in place to ensure the well being of service users. The inspector observed staff interacting with service users. Service users were treated with respect and dignity and their comments and requests were dealt with in a supportive and professional manner. All arrangements were in place for the healthcare needs of service users. The arrangements are robust. Service users care plan focuses on healthcare needs. Their care plan evidenced support to access professionals in healthcare. They also have evaluations and review dates for their Care Plan Approach (CPA) meetings. Comment cards from a G.P. and the Consultant Psychiatrist were received by the Commission. The comments sent were discussed with the manager. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 Page 14 Arrangements were in place in terms of medication. Policies and procedures were in place. Medication is collected, stored, disposed of and administered appropriately. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 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 Service users feel well regarded and safe. The home has robust arrangements for the safety of service users. EVIDENCE: Complaints policies and procedures were in place. In discussion with the manager, service users, the examination of staff files and the complaints book it was evident that complaints were dealt with appropriately. Regulation 37 and levels of complaint was discussed with the manager. The inspector advised on the layout of the complaints. A recommendation has been made. Service users spoke highly of their key-worker, staff in general and the manager. They said they felt free to discuss any issues and knew who to complain to. Staff files were examined which evidenced all relevant training including the Protection of Vulnerable Adults (PoVa). Staff confirmed training, induction and follow up training. Staff confirmed training was good and were clear about what to do in terms of Protection of Vulnerable Adults and Whistle-blowing (reporting abuse). The Home’s Intranet system reminds staff to read the latest bulletins, information and training updates, and will notify staff when a new oplicy has been issued or changed. The organisation’s entire policies and procedures are on the intranet and each staff member has an individual account. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 Page 16 Service users handle their own finances. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 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): 24 & 30. The Home is purpose built, originally a hostel. Given the layout, the home has touches of homeliness. Service users personalise their room to their own taste. Service users are in part responsible for the cleanliness of the Home. EVIDENCE: The Home used to be a hostel and efforts are made by the management to add touches of homeliness, such as pictures on the walls, flowers in hallways, and pleasant decoration. The Home has a rolling 5-year maintenance and refurbishment programme which was in progress at the time of the inspection. The Home has a domestic to undertake general house cleaning. However, service users’ programme is for daily living skills and they are expected to contribute to the cleaning chores. Self-catering service users are responsible for ensuring that the shared kitchens are kept clean. In view of service users’ responsibility for some of the cleaning, the home was clean and hygienic. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 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): 32, 34 & 35. Staff are well qualified. St George’s House ensures staff have the necessary training to provide support staff appropriately. The Home’s recruitment procedures ensure the protection of service users. EVIDENCE: Staff files were examined. Roles and responsibilities were clear. The Home’s recruitment procedures ensures that well qualified staff are employed, however the Home does experience a fast turnover of some support staff. The management are researching what and how staff retention could be improved, and are also considering increasing staff ratios. The home is aware of the lack of continuity of care to service users and want to change this. The Home’s training programme ensures staff gain the relevant induction and ongoing training to provide appropriate and safe support to service users. St George’s has a robust recruitment policy and procedure to ensure service users are protected. The checks on references were robust, each place of employment’s reference was double checked. Criminal Records Bureau (CRB) checks are undertaken. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 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): 37,38, 39 & 42. The Home is managed to a high standard by a well qualified and competent manager. Service users and staff feel confident to discuss issues with the manager. The manager ensures service users benefit from the Homes policies, procedures and staff approach. EVIDENCE: The manager is registered under the Care Standards Act 2000 with the Commission and expects to complete the National Vocational Qualification – Level 4 in Management in 2006. In discussion with the manager, it was demonstrated that the manager was aware of some shortcomings, such as staff turnover and staff ratios and advised discussions with senior management was in the pipeline. It was also demonstrated that despite the vacancy of a significant post, the Home was at pains to ensure that only a suitable person was recruited so as to ensure the best interest of service users. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 Page 20 Staff confirmed the manager was approachable, and that supervision and appraisal was regular. A sample of service users agreed to meet with the inspector. Their praise of the manager, management, staff and key-workers was high. Some of their comments were: “ … I was at another home which didn’t care. This is probably the best place – key-workers work hard. We have key-worker meetings and everything is planned with me. I never have a complaint, I can go to any staff. I can come and go as I please as long as I let them know in advance. There are lots of groups meetings. Thursday meetings when (the manager) leads everything is discussed, and you can complain there if you want to.” Another resident said: “It’s better than I thought it would be. Staff treat you as equal – not authoritarian. All staff are very professional. I’ve got a Care Plan, based also on information from my G.P. If I don’t agree with the Care Plan I can correct them which is really good. I’ve come to a good place …. “ St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 4 X X X Standard No 22 23 Score 3 4 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 4 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St George`s House Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X X 4 DS0000020978.V264221.R01.S.doc Version 5.0 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 Requirement Timescale for action 15/01/06 2. YA1 4(1)(a)(b), The Registered Person must 4(2), produce a Statement of Purpose and Service User Guide as required under the Care Standards Act 2000. 5(1)(aSee Above f),(2)(3) 15/01/06 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 2 3 Refer to Standard 7 9 22 Good Practice Recommendations To indicate the reason when a service user refuses to sign the Care Plan. To undertake robust risk assessments for staff. To consider the layout of the Complaints Book so as to identify easily the outcome of the investigation of a complaint, and to be able to analyse type of complaints for quality assurance. St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St George`s House DS0000020978.V264221.R01.S.doc Version 5.0 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. 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