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Inspection on 25/10/05 for St Mungos Association

Also see our care home review for St Mungos Association for more information

This inspection was carried out on 25th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Long term alcohol abuse can cause problems with memory and recognition. The home tries to support residents to remain aware of decisions made by providing copies of the minutes of review meetings, the care plan, the name of their social worker etc in a file which is kept in the resident`s room. A comprehensive programme of activities is on offer in the home to provide a more stimulating life style for residents and to offer opportunities in their lives as an alternative to drinking alcohol. The success of the poetry and current affairs group demonstrates the commitment of the life skills worker and members of staff to encourage residents to socialise.

What has improved since the last inspection?

The home is now using a system to identify when review meetings are next due so that if it is an external review meeting the placing authority can be contacted in advance of the due date and asked to convene a meeting. It was noted during the trial period of serving the main meal at midday rather than in the evening the number of residents using their money to purchase a main meal of has increased. Eating regular balanced meals improves the health and well being of residents.

What the care home could do better:

Records of the administration of medication to residents must be up to date and complete. There is a system in place to check at handover meetings that medication records are complete. However, when gaps are discovered, an investigation must identify the action needed to prevent or to minimise the possibility of this happening again. The action taken should be recorded on the sheet. As gaps in the recording were in relation to the administration of creams and inhalers a review of the current practice should be undertaken. It was noted that the gaps occurred mainly when agency and locum staff were paired together. A review of the shifts worked by staff should be undertaken so that a permanent experienced member of staff is one of the two persons on shift responsible for administering medication.

CARE HOME ADULTS 18-65 St Mungos Association 53 Chichester Road London NW6 5QW Lead Inspector Julie Schofield Unannounced Inspection 25th October 2005 09:45 St Mungos Association DS0000017439.V261203.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 Mungos Association DS0000017439.V261203.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 Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Mungos Association Address 53 Chichester Road London NW6 5QW 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) 020 7624 4453 020 7328 2438 St Mungo Association Mr Micheal Dunne Care Home 27 Category(ies) of Past or present alcohol dependence (27) registration, with number of places St Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th July 2005 Brief Description of the Service: Chichester Road is one of a number of projects run by St Mungos Association. It is a wet home for men and women with alcohol dependency needs and is registered to accommodate 27 service users, many of whom have been rough sleepers. Staff provide encouragement and support, including assistance with personal care and help with managing finances. Staff give information and support in respect of the service users health care needs and advice regarding the importance of eating well is supplemented by the appetising meals offered. There is a life skills worker who organises a programme of activities, both inside and outside the home. There are bedrooms and bathrooms on the ground, first and second floor. There is a lift that links the ground and first floor and there is a TV room (dry room), a games room (wet room) and a dining room on the ground floor. Service users use the garden areas at the front and the back of the building when the weather is fine. St Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on a Tuesday in October and started at 9.45 am. The inspection finished at 1.45 pm. The Inspector would like to thank the manager, staff and residents who took part in the inspection. A partial site visit took place, records and medication were inspected and a discussion with the manager took place. Residents spoke positively of the service received. What the service does well: What has improved since the last inspection? The home is now using a system to identify when review meetings are next due so that if it is an external review meeting the placing authority can be contacted in advance of the due date and asked to convene a meeting. It was noted during the trial period of serving the main meal at midday rather than in the evening the number of residents using their money to purchase a main meal of has increased. Eating regular balanced meals improves the health and well being of residents. St Mungos Association DS0000017439.V261203.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 Mungos Association DS0000017439.V261203.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 Mungos Association DS0000017439.V261203.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): Standard 2 was inspected during the previous inspection. EVIDENCE: St Mungos Association DS0000017439.V261203.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 Standard 9 was inspected during the previous inspection. Evaluating and reviewing care plans on a regular basis ensures that changes in the needs of residents are identified and can be addressed. The home respects the right of residents’ access to information, relevant to their life in the home, and ensures that a file is provided in the resident’s room, where suitable. Residents exercise their right to make decisions within their day to day living and are assisted by members of staff when alcohol abuse has interfered with their ability. EVIDENCE: The home has developed a Joint Action Plan Review for internal reviews and the format covers personal, health and social care needs. It includes discussions between members of staff and one to one meetings between the key worker and the resident. The manager showed the Inspector a copy of a sheet for recording the date of the last review meeting and date when the next meeting was due. Setting up a system for monitoring the regularity of reviews and making sure that contact was made with the placing authority, if the review meeting was overdue, was identified as a requirement during the last St Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 Page 10 inspection. A discussion took place about the changing needs of a resident and the action taken by the home to arrange for a reassessment of his needs by the Placing Authority. Some residents find it helpful to have information in their room to refer to and this may include the house rules, the aims and objectives of the home, minutes of the most recent review meeting, the care plan, minutes of the residents’ meeting and the name of the social worker. The home is to be commended for this practice. The level of assistance needed by each resident in making decisions about their life is determined during the admission process and is then monitored and amended, as necessary. The handling of the resident’s finances is subject to agreement, prior to admission, and help with budgeting enables a resident to have sufficient money to eat well. (Only the breakfast is provided in the fees although residents are able to purchase a nourishing meal at a very reasonable cost). Five residents have appointees acting on their behalf. Where residents are unable to make informed decisions due to increasing memory loss and confusion advocates have been arranged. St Mungos Association DS0000017439.V261203.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, 16, 17 Standards 13 and 15 were inspected during the previous inspection. Providing activities for residents, both inside and outside the home, offers residents an opportunity to develop their social and communication skills and to enjoy an interesting and stimulating lifestyle. The respect for the resident’s right of choice was demonstrated in the way in which residents lived their lives, as they wished. Residents are offered a balanced and varied diet, with dishes to satisfy cultural needs. EVIDENCE: During the inspection the life skills worker was on duty. There is an enthusiastic poetry and current affairs group and poems were being displayed in the activities room. One of the residents recited examples of their work. The life skills worker was preparing information as part of Black history month. The manager said that the home had held a London week and there were photographs on display of the visit of pearly kings and queens to the home. He said that the St Lucia day in the summer had been enjoyable. The activities arranged include health education sessions by the dietician and by a St Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 Page 12 nurse. The home now shares a vehicle with 3 other St Mungo’s establishments, although it is parked at Chichester Road. The manager said that staff knock on the resident’s bedroom door before entering to give medication. Residents have a key to their bedroom doors and letters are given to them, unopened. Residents can choose whether to take part in activities and they enter and leave the home as they wish. They have access to the communal areas at all times. The consumption of alcohol, in what areas of the home and in what amounts, form part of the house rules and the contract of residence. The catering is contracted out. During the inspection the main meal of the day was served at lunchtime. The main dish was fish and alternatives were available. The menu is varied and balanced and respects the cultural and religious needs of residents. It was noted that there were more residents sitting in the dining room than on previous inspections, when the main meal has been served in the evening rather than in the middle of the day. The manager said that the timing of the main meal had been changed for a trial period and as more residents were returning to the home for a main meal the overall well being of residents had increased. St Mungos Association DS0000017439.V261203.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, 20 Residents receive assistance with or prompting with personal care in a manner, which respects their privacy and dignity. Incomplete medication records compromises the effectiveness of support given to residents with their medication. EVIDENCE: There is always at least one care assistant on duty each day between the hours of 9 am and 5 pm. Assistance with personal care is required by some of the residents and these residents occupy rooms on the ground floor. Residents on the first and second floor require varying levels of encouragement and monitoring. At present there are no female residents living in the home and there are male and female members of staff on duty. When specialist support and advice is needed the manager said that referrals are made through the GP. The home has a system of key workers and 1 to 1 sessions take place between key worker and resident. Medication storage, handling and recording was inspected. The storage was secure although the room felt warm. The home uses a weekly blister pack system and these had been appropriately dispensed prior to the inspection. Records were inspected and there were gaps in the recording. The home had a system for checking at handover if there were any gaps in the recording. It St Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 Page 14 was noted that gaps were in respect of the administration of creams and inhalers. The manager said that these were not given in communal areas and it was possible that the resident had left the home before they could be given and that a refusal had not been noted in the records. It was noted that the discrepancies occurred with a particular pairing of staff (agency and locum). St Mungos Association DS0000017439.V261203.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): Standards 22 and 23 were inspected during the previous inspection. EVIDENCE: St Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 30 Standard 24 was inspected during the previous inspection. Residents enjoy comfortable communal areas in which they can relax, socialise or take part in activities. Residents live in a home where standards of cleanliness are good. EVIDENCE: The inspection took place on a fine day and residents were sitting on the benches outside the front of the house. There is also seating in a garden area, which is behind the dining room. Inside the home there is a television room, which is a “dry” room and an activities room, which contains a pool table and is a “wet” room. Neither room was crowded, as although these are used, residents may prefer to go out or may prefer to spend time in their rooms. Rooms are decorated and furnished in a homely manner and residents said that they liked the home and found it comfortable. They said that they enjoyed using the garden. Bedrooms were not inspected but other parts of the home were seen. It was noted that the home was clean and tidy and free from offensive odours. A resident confirmed that the home is kept clean. Laundry facilities are situated on the ground floor, away from the kitchen or dining room. The washing St Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 Page 17 machine has a sluicing cycle. There is an infection control policy in place and staff receive infection control training. St Mungos Association DS0000017439.V261203.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, 33, 35 Standard 34 was inspected during the previous inspection. The rota demonstrated that there were sufficient staff on duty to support the residents and to meet their needs. The home has a training and development plan for ensuring that training provided enables staff to meet the objectives contained in the Statement of Purpose and is tailored to meet the individual and changing needs of residents. The home continues to support staff undertaking NVQ training. EVIDENCE: A discussion took place regarding the programme of NVQ training for staff. The manager said that 3 staff have achieved at least an NVQ level 2 qualification and that 2 staff were about to start their level 2 training. One of the staff that has been offered a post in the home already has achieved their NVQ level 2 qualification. During the inspection the manager, the deputy, 2 project workers, a care assistant, the life skills worker, a cook and a janitor were on duty in the home. It was helpful to residents, some of whom are suffering with short memory loss, and to visitors to the home, that a board containing clearly named photographs of each member of staff was on display in the entrance hall. The home is still using agency staff to cover some of the shifts in the home as staff St Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 Page 19 that were recruited in June are still waiting for their CRB clearance before they can commence duties. There is a training and development plan for the home and training provided to staff includes induction and foundation, mandatory, intermediate and advanced training. Training includes NVQ training. The company employs a training officer and while there is a central training budget the home also has a training budget and this was used to arrange infection control training for the staff team. The manager said that he was hoping to arrange cognitive impairment and communication training for staff. Annual appraisals, which include a performance review and formulation of a training profile for the member of staff, are due to take place in November. St Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 Quality assurance systems identify satisfaction with current services and changes in the needs and expectations of residents. This information shapes the development of the service as it is incorporated into business planning. EVIDENCE: A copy of the draft St Mungo’s Annual Project Review and Planning Document, which was dated October 2005, was available. The review covered the purpose of the project, the project’s performance, key success indicators, staffing and training, external relationships, stakeholder analysis, value for money, and service user involvement. The manager said that the results of the annual residents’ satisfaction survey were needed before the document could be completed. He expects to receive these soon and the home has a system of discussing the results during the weekly residents’ meeting. In addition to residents’ meetings feedback from residents is obtained during key working sessions and with the manager’s “open door” policy. The manager said that sometimes the placing authority visited the home as part of monitoring the service or updating knowledge as part of the approved supplier St Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 Page 21 status of the home. During these visits the representative of the placing authority talked to residents and checked whether the home was meeting standards. Regulation 26 visits are carried out monthly by a service manager within the company. The company has a Performance Support Unit, which reviews the policies and procedures. St Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X 3 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St Mungos Association Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X X X DS0000017439.V261203.R01.S.doc Version 5.0 Page 23 NO 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 YA20 Regulation 13.2 Requirement That records of the administration of medication to residents are up to date and complete. That 50 of staff supporting residents achieve an NVQ level 2 qualification. Timescale for action 01/12/05 2 YA32 18.1 31/12/05 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 Refer to Standard YA20 YA20 Good Practice Recommendations That a thermometer is provided in the medication room to monitor the temperature. That the sheet used to identify any gaps in the records of the administration of medication includes a note of the action taken, after investigation, to prevent any possible repetition. That one of the two members of staff who are responsible for administering medication on the shift is a permanent member of staff. 3 YA20 St Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Mungos Association DS0000017439.V261203.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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