Inspection on 16/04/07 for St Mungo`s

This inspection was carried out on 16th April 2007.

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

Other inspections for this house

St Mungo`s 06/04/06

St Mungo`s 12/09/05

St Mungo`s 11/04/05

St Mungo`s 02/11/04

St Mungo`s 20/04/04

Similar services:

Ashlong House

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Herbert Street

Stacey Street Nursing Home

Haven (The)

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

CARE HOME ADULTS 18-65 St Mungo`s 2 Hilldrop Road Tufnell Park London N7 0JE Lead Inspector Pearlet Storrod Unannounced Inspection 16th April 2007 10:00 St Mungo`s DS0000020973.V332794.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 Mungo`s DS0000020973.V332794.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 Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Mungo`s Address 2 Hilldrop Road Tufnell Park London N7 0JE 020 7700 6402 020 7607 2235 roberts@mungos.org 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) St Mungo Community Association Limited Manager appointed but not yet registered 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) St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 20.12.2007 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 aged 50 and over 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. The fees are currently £720.65 including all meals. Service users are required to pay a contribution towards the cost of their care and support needs. People under age 60 pay £60.95 and those aged 60 and above pay £98.60 . St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 16 April 2007, in a timescale of 7 hours. The time was spent talking with the appointed manager, a few staff members, some service users, examination of the records and scrutiny of staff records and service users’ files. A tour of the building was carried out. The previous key inspection occurred on 6.4.2006 followed by a random inspection on 20.12. 2006. Requirements from both inspections were examined for compliance. The appointed manager asserted that he found the inspections to be very helpful. A number of the requirements from both the last key and random inspections are including in the report for attention. What the service does well: What has improved since the last inspection? Improvements have been made to the majority of the requirements and recommendations in the previous reports. Changes to the meal arrangements have made a significant difference to the lives of people who use services, some of whom have reduced their alcohol consumption. St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 6 Refurbishment to the bathrooms and toilets has vastly improved these facilities. The upgrades have increased the quality of life, independence and well being of people who use services. 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. The summary of this inspection report can be made available in other formats on request. St Mungo`s DS0000020973.V332794.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 Mungo`s DS0000020973.V332794.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): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The previous report required that the information within the Service Users Guide and Statement of Purpose are consistent with regard to the age for admission and timescale for complaints. Previously, pertinent information was missing from the some of the files of people who user services EVIDENCE: Improvements have been made in regard to the Statement of Purpose and Service Users Guide in respect to the age groups of 50 plus for admission of people who use services and the timescale of 5 days for a written response to complaints. The profiles for people who use services have also been reviewed and amended as appropriate. There is evidence of comprehensive needs assessments of people who use services and staff are pro-actively working to ensure that a consistent approach is applied for current and prospective people who use services. St Mungo`s DS0000020973.V332794.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use services know that that their individual needs are assessed and that their goals along with any planned changes are reflected in their individual plans of care. There is evidence that care plan reviews occur though the progress of achievement was not evident in the sample of care plans seen. EVIDENCE: A general discussion about the care plans and evaluation process occurred and a very good example of the way in which the assessed needs of an individual who use services was seen. Staff are working hard to ensure that the care plan for people who use services are undertaken in a consistent manner and that all information gathered are used so that a picture of the whole person is portrayed. It was pleasing to see the set goals of people who use services recorded in care plans though the plans are repetitive with no evidence of progress and or St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 10 outcomess recorded in them. For example, an individual who regularly attends a day hospital to check his progress in respect to his memory, does not have the level of progress recorded as part of his care plan. Staff should know whether the home needs to take any approaches in a consistent way that would assist the individual to improve his memory, if no progress is being made in this respect. This is particularly important since the goal set by the individual in his clear plan is to improve his memory. Interestingly enough, this individual spoke to me during the inspection about wanting to improve his memory. The progress of achievements is not recorded in the evaluation section except that staff would continue to assist him to prepare and attend the appointments. The manager and his staff have given an undertaking to improve their current systems and practice in this respect. Remarkable improvements have been made in respect to the risk assessments and where necessary, physiotherapy assessments, which shows a reduction in the levels of falls in the home and enhanced independence to some individuals’ lifestyles. St Mungo`s DS0000020973.V332794.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): 12,13,15,16 and 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 services follow their preferred lifestyle as far as they are able and individuals’ cultural needs are now taken into consideration in planned activities. Changes in respect to the risk assessments and meal arrangements have made significant impact to the quality of life for the people who live at Hilldrop. EVIDENCE: Five of the people who use services were spoken to individually and as a group. One of the life skills workers’ gave an example of the activities that people who use services participated in. Life skill workers are integral to the service and they play an important role in ensuring through consultation that people who use services lead an independent lifestyle as possible by arrange an assortment of activities according to choice, hobbies and wishes. Some of the activities include dancing at the Irish Centre, reminiscence, exercises and trips to various places. The manager said, people who use services enjoy the themed events, an idea that stemmed from the previous inspection. Those spoken with believed that the home provides a good service and one individual St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 12 said, “I give it full marks”. Another said, “there is nothing wrong here, everything is all right”. Various action plans with consent and designated signatories have been set up to facilitate those people who want to abstain from drinking alcohol for medical reasons. There is evidence that staff are support some others in the same way with smoking. It is noted in two care plans seen that one individual is managing to his smoking of cigarettes in a planned way. A similar approach is used for another person in respect to drinking; on my arrival to the home I observed a woman hand a can of beer to this individual, which defeats the objectives, the set goal that the home and individual are hoping to achieve in this aspect. People who use services continue to be encouraged and supported to maintain contacts with friends and families. Discussion was held with the cook, her assistant, support staff and people who use services and they all confirmed that the changes made to the meal arrangements have seen an increase in the take up of meals. As much as 98 of the people living at the home is said to be eating regular meals. I have to say that from my observation, the people residing at Hilldrop appears to be more content, relaxed and there was good interaction between the cook and people who use services. The cook commented that standards within the home have improved all round since the last inspection. St Mungo`s DS0000020973.V332794.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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal and healthcare support for people who use services have much improved since the last inspection. EVIDENCE: Domiciliary care workers no longer provide personal care services to people who use services at this home. These tasks are now undertaken directly by the home’s project and care workers. This change in approach is a welcoming one as it offers consistency and continuity of care that could only enhance the quality of life and well being of those living at the home that require this type of support. There is evidence of more input from health professionals such as physiotherapist and psychologist as necessary and additional recordings in aspects of care for people who use services are apparent. The number of people who use services currently in need of personal care support is five, one of whom is doubly incontinent. Three people have been transferred to a nursing home since the last inspection and four people passed away. St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 14 There was an increase in the number of falls since the previous inspections and steps have been taken to reduce these by the introduction of a more robust risk assessment tool, which is proving to be effective. Two people of the people who use services were transferred to a nursing home as a result of falling and changes to their needs. Much improvement has been made at Hilldrop in regard to personal and healthcare support for people who use services since the previous inspection. The MAR charts were examined and these were found to be generally satisfactory. The home is to discuss with the contracting pharmacist about the continuous recording of discontinued medication on the MAR charts for people who use service. In house training in respect to the management of medication occurred on 8.2.2007 and further training is being pursued. One person self-medicates for whom a risk assessment has been drawn up by the staff in consultation with the individual concerned, though this individual is reluctant to have an additional cabinet that is lockable in his room for his medication. Since the individual stores his medication is his draw, it would be of benefit to make the draw lockable to secure his medication. One other requirement remains outstanding from the inspection conducted by the Commission’s Pharmacist and this relate to and expansion and update of the home’s medicines policy. The provider produces a number of their policies and procedures organisationally and has asked for more time to comply with this requirement. The home is in the process of drawing up a list of names with specimen signatures and initials of those staff trained in the safe handling of medication. St Mungo`s DS0000020973.V332794.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): 22 and 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to enable people who use services to air their views and to have them acted upon. Systems are in place that ensures the protection of people who use services. EVIDENCE: Since the last inspections there have been eleven complaints made to the manager, all of which have been appropriately acted upon within a reasonable timescale. On the inspection day, those spoken with had no complaints to make; the people who use services at the home paid compliments to the way that the home is run, with an individual giving it full marks. This is to be commended. An updated copy of Islington’s Adult Protection Protocol is now in place and it has to be said that a strategy meeting though still on-going, has been useful in ensuring that an improvement in the quality of care provided is evidently so. The practice of using tippex on the financial records of people who use services have ceased and examination of the records showed that these are better managed with two signatures applied to every transaction, whether staff and person using the service or the manager and another member of staff. St Mungo`s DS0000020973.V332794.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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises provide a safe and homely environment for people who use services but further work is necessary to enhance the environment as a whole. EVIDENCE: Since the last inspection each room occupied by people who use services has been provided with a new piece of lockable furniture for their personal belongings. A safer environment is now evident with alarms fitted to the front door and emergency exits. This enables staff to keep a monitor people leaving the home and putting themselves at risk of harm. Refurbishment works have been completed in respect to the bathrooms and toilet facilities, though the base of the toilet bowl sited in the wc room between rooms 2 and 3 was broken and needs to be replaced. The people who live here now have a more comfortable environment in which to live. From observation of the internal features of the home, the carpets in the corridors on all floors are in poor conditions and needs to be replaced to provide an even more St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 17 pleasant environment. Also the base units in the library are in a state of disrepair and these too needs to be addressed. The domestic staff had a late lunch to ensure that the home was appropriately clean in readiness for the inspection. She confirmed that there are no domestic staff on duty over the weekends, which means that excess cleaning of all the communal areas within the home is necessary to enhance the independence and quality of life for people who use these services. The home was found in a clean and hygienic condition following the application of the domestic staff ‘s cleaning regime and enthusiasm. St Mungo`s DS0000020973.V332794.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use services benefit from an experienced and effective staff team, appropriately trained to meet their needs. EVIDENCE: Staff were observed carrying out their duties and the care and support provided in respect to two of the people who use services were cross referenced with the records, discussion with staff and the individuals concerned. Hilldrop has an enthusiastic staff team who works conscientiously to improve the quality of care and support services at the home for the people who use the service. Staff at all levels demonstrated a caring attitude and commitment in the work that they undertook. The previous report asked that a review in respect to the level of staffing is conducted and this was in conjunction with the high levels of dependency that existed, to an extent that domiciliary care workers had been introduced to provide personal care and support to some of the people who use services. St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 19 The situation has changed though currently there are three vacant posts for which agency staff are being used to supplement the staffing complement. A recruitment drive is taking place. As there is only one domestic cleaning staff that works Monday to Friday, the manager must ensure that cleaning of the home occurs at weekends. Staff are appropriately trained and a staff member talked about being on advance alcohol, which included the safe handling of medication for people who are alcohol dependent. Two staff members have completed NVQ level 3 and one person is in the process of completing the same course. Staff appraisals have begun to occur. St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 20 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that people who use services are kept safe and secure inside and outside the home. EVIDENCE: The previous deputy manager was successfully appointed as manager for the home and now needs to be registered by the Commission. The provider confirmed during the inspection that not pursuing the registration was an oversight. The manager was advised that the application for registration of the manager could be downloaded from the Commission’s web site, or alternatively to contact the Commission’s Regional Registration Team for an application form. He agreed to pursue his registration with some urgency. The home continues to be well managed and a number of improvements have been made since the previous visits, including reviewing of some policies and St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 21 procedures such as risk management. A range of documents was examined including employers liability insurance, accident reporting and complaints. A quality assurance survey is conducted by the organisation on an annual basis and the information gained is used to improve the service. Health and safety documents observed showed that these were current and the manager reported that the yellow bags for continence waste are no longer delivered freely and as a result they have had to engage waste disposal contractors to supply and dispose of waste materials. St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 22 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 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 2 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 x 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 23 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 YA6 Regulation 15 Requirement The registered provider must ensure that care plans are evaluated with recorded progress and outcomes Restated from 30/06/06 Timescale for action 30/07/07 2. YA20 13(2) 30/07/07 The homes medicines policy must be expanded and updated. When complete there must be a list of specimen signatures and initials of those staff trained in the safe handling of medication. Additional training is being pursued and a request was made for an extended date for compliance. This was agreed. The registered provider must continue with the general improvements being made. This includes the replacing the carpets in the communal areas that are in poor condition and to replace the base units in the library that in a state of disrepair. This is restated from 30/12/06 30/10/07 3. YA24 23 St Mungo`s DS0000020973.V332794.R01.S.doc Version 5.2 Page 24 4. YA27 27 5. YA33 18 The registered provider is 30/05/07 required to replace the broken toilet on the ground floor between rooms 2 and 3 The registered provider is asked 30/07/07 to ensure that cleaning the home occurs at weekends. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations That there continues to be regular audits and assessments of competency for all staff handling medication. 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