CARE HOME ADULTS 18-65 St Mungos 2 Hilldrop Road Tufnell Park London N7 0JE
Lead Inspector Beverley Brewer Announced 11 April 2005 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 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 Stationary 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. Version 1.10 Page 3 SERVICE INFORMATION
Name of service St Mungos Address 2 Hilldrop Road Tufnell Park London N7 0JE 020 7700 6402 020 7607 2235 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) St Mungo Community Association Limited Todd Sinclair Care Home 29 Category(ies) of Past or present alcohol dependence (29), Mental registration, with number disorder, excluding learning disability or of places dementia (29), Mental Disorder, excluding learning disability or dementia - over 65 years of age (29), Physical disability (29) Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Home registered for men and women with needs relating to Alcohol dependency together with mental disorder, physical disability and/or old age. Maximum of 29 beds within the above facility Date of last inspection 02/11/04 Brief Description of the Service: 2 Hilldrop Road is a care home situated off Camden Road. The home provides care and support for 29 men over the age of 45 who have experienced homelessness combined with mental health issues and/or alcohol dependency. The home is owned and managed by the St Mungo Association.2 Hilldrop Road is a listed building which was converted from a church in 1990. Staff support service users in developing harm minimisation programmes to help them to manage their drinking. The staff team also assist service users to access mental health services in the local community. At the time of this inspection 17 of the 29 service users were over 65 years of age. Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first announced inspection within the new inspection schedule from 1st April 2005 to 31st March 2006. The inspection took 7 hours during a weekday. The majority of the time was spent speaking with both managers, service users and members of staff. The remainder of time was spent examining records, touring the premises and observing the interaction between staff and service users. Comment cards were sent out with the preinspection material and four were returned. What the service does well: What has improved since the last inspection?
The physical standard of the building has improved considerably over the past year. New furniture and bedding has been purchased for service user’s bedrooms and the standard of cleanliness has also improved. Service users reported that the life skills worker post had improved the quality of their experience of living at Hilldrop. Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Version 1.10 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 standard(s) 2 & 5 This service has a planned admission process, which ensures that service users’ needs can be met following a full assessment. Each service user has an individual written contract and individual licence agreement. EVIDENCE: The home has a documented admission criteria and all referrals come via the local authority care management system. Three files were examined in detail. All three had copies of the Comprehensive Needs Assessment, a Care Programme Approach care plan and a comprehensive risk assessment. The quality of recorded information was good. Individual licence agreements were signed by service users and were in each of the three files. Version 1.10 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 standard(s) 6, 7 & 9 There is a clear care planning system in place that involves the service user and provides staff with sufficient information to meet the needs of service users. EVIDENCE: All files examined had an individual plan of care drawn up in conjunction with the service user incorporating the Comprehensive Needs Assessment and the CPA care plan and risk assessment as appropriate. Copies of budget agreements were available for inspection. Staff adopt a harm minimisation approach whereby service users are encouraged to agree a daily limit on money to spend on alcohol. Version 1.10 Page 10 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 standard(s) 12,13,14,15,16 and 17. Service users ability to participate in community activities is severely compromised by their previous experience of homelessness and their present alcohol misuse and/or mental health problems. The present meal arrangements do not promote service users health and wellbeing. EVIDENCE: Service users reported positively on the role of the life skills worker post stating that they enjoyed the range of in house activities available. The majority of service users are not able to continue with their education or training due to their age, alcohol use or mental health problem. The present meal arrangements whereby service users can choose whether or not to purchase a meal do not appear to promote health and wellbeing as service users may choose to spend this money on alcohol. Version 1.10 Page 11 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 standard(s) 18,19 & 20 Arrangements are in place to meet the health and welfare needs of the service users although the level of engagement is dependent on the service user. Staff are unclear as to the meaning of some of the administration codes used to record medication dispensed. EVIDENCE: The care planning process addresses the health care needs of the service users. All service users are registered with a local G.P. Care plans indicate the involvement of other health care professionals. A number of service users are patients of the Care Programme Approach. Risk assessments were available on all files examined. Accident records are appropriately maintained. Service users stated that they were consulted on how care was delivered. Medication training is available for staff and staff questioned stated they had attended appropriate training however there were two gaps in the administration record. There was disagreement amongst staff as to the meaning of the administration codes. Version 1.10 Page 12 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 standard(s) 22 & 23 The home has a satisfactory complaint’s process with evidence that service users feel that their views are listened to and acted on. EVIDENCE: The home has a satisfactory complaints procedure, which is known by both staff and service users. A copy is incorporated into the service user guide. There is a system in place to record and monitor complaints. Records indicate that one complaint was made which was partially substantiated. All complaints have been responded to in 28 days. No complaint has been sent directly to the Commission for Social Care Inspection The home has a whistle blowing procedure and an adult protection policy. Regular training opportunities are available. There are policies in relation to handling service user’s finances and gifts. Version 1.10 Page 13 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 standard(s) 24, 25 & 30 Physical standards at Hilldrop Road have improved considerably over the last year. Although comfortable the building is institutional in size and shape and is not homely. EVIDENCE: Cleanliness throughout the home has much improved over the last year. The present manager has embarked on a renewals and replacement programme. Many of the bedrooms have had new furniture and bed linen. New flooring has been provided in some rooms and communal areas. The building is well maintained. Service users stated that they had everything they required in their rooms. Bathrooms still require refurbishment although work is due to commence within the previously agreed timescale. Version 1.10 Page 14 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 & 35 The registered person operates a thorough recruitment procedure and staff have access to relevant training however the present staffing levels allow little time for individual work with service users. EVIDENCE: Personnel records were available for inspection. Posts are advertised externally and job descriptions were available. CRB checks are undertaken on all staff prior to taking up employment and two references were available on each staff file examined. Training manuals are sent to the home from head office. Staff confirmed that the training offered was of good quality. Present staffing levels allow very little time for individual work with service users. Staff were observed spending the majority of their time in the office dispensing medication, answering the telephone and assisting service users with their daily finances. Version 1.10 Page 15 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 & 42 Service users have opportunities to comment on the service as a whole and on their individual care. The health and safety of service users is protected. EVIDENCE: Regular house meetings occur and minutes are taken. There is a St Mungo’s wide service user involvement steering group which holds monthly meetings. Hilldrop service users have been involved in the Groundswell primary research project which is looking at service user involvement throughout the projects. Health and safety is well managed at Hilldrop. Appropriate records are maintained and risk assessments were available. Version 1.10 Page 16 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 3 x x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x x x x 3 Standard No 11 12 13 14 15 x 3 3 2 3 Standard No 31 32 33 34 35 36 Score x x 2 3 3 x Version 1.10 Page 17 16 17 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x Version 1.10 Page 18 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 YA12 Regulation 14 Requirement Timescale for action 31/3/06 2. YA17 16(2)(i) 3. YA20 13(2) 4. YA33 18 Service users must be given the option of a minimum seven day annual holiday outside the home which they help choose and plan. The registered person is asked to 31/12/05 review the present arrangements with regard to meal provision so that meals are included in the weekly charge ensuring that service users health and wellbeing is promoted. This requirement is restated. The registered person must 30/9/05 ensure that an accurate record of medication administered is maintained and that staff receive training in medication recording. The registered person is asked 31/12/05 to review the present staffing levels to provide more staff time for individual work with service users. 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 Good Practice Recommendations
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