2.Methodology: How Link Carried out the Research

Contents

1.Introduction

1.1About Islington LINk

1.2About ‘Enter and View’

1.3Why the LINk is visiting the service

2.Methodology: How LINk carried out the research

3.Findings...... 2

3.1Observations....... 2

3.2Interviews with residents and relatives...... 3

3.3Interviews with staff...... 3

4Summary of findings...... 5

5.Recommendations...... 5

Appendix A: Preliminary questions...... 6

Appendix B: Service User questions...... 8

Appendix C: Observation Checklist...... 11

1. Introduction
2. Islington LINk

Islington LINk (Local Involvement Network) is an independent organisation, led by a network of elected volunteers from the local community (both individuals and representatives of community and voluntary organisations). LINks were set up in every local authority area in England in 2008, under the Local Government and Public Involvement in Health Act 2007, andare a channel for the community voice on health and social care services.

Through this work, LINks help the London Borough of Islington and the NHS to provide an improved quality of health and adult social care services that better reflect local needs. All LINk reports are shared with relevant local statutory partners and the Care Quality Commission, the regulator of health and adult social care services.

1.2What is Enter and View?

Under Section 225 of the Local Government and Public Involvement in Health Act 2007 LINks have a right to ‘Enter and View’ publicly funded health and social care services. This right enables LINks to assess service standards and to gather the views of service users. The Enter and View team members hold a current, enhanced level CRB check and have undertaken a six session training course, including guided visits, in Enter and View.Islington LINkhas developed a protocols for visits which can be seen on our website:

Or a copy can be requested from the LINk host, Voluntary Action Islington.

1.3Why the LINk is visiting care homes for people with mental health needs

Islington LINk visited several care homes for older people in 2011-12.

We wanted to ensure maximum benefit from our visits in 2012-13. This meant that our visits needed to complement but not duplicate inspections planned by the national regulator, the Care Quality Commission. After discussion with the CQC local compliance manager, we developed a plan for a series of visits to services that had not been recently inspected by CQC, and were not about to beinspected. This would include some repeat visits to homes visited in 2012-13 to see what progress had been madeas well as some new visits. In the previous year, the LINk had carried out two visits to each selected care home: an announced visit followed two months later by an unannounced visit. For reasons of capacity and workload in 2012-13, we were able to carry out only one, announced, visit to each selected service, but reserved the right to follow up if necessary.

After discussion with the local CQC compliance manager, and in recognition of the fact that LINks rarely visit services for people with severe mental health needs, we decided to visit Wilton Villas and New North Road, two connected residential services run by St Martin of Tours.

Wilton Villas and New North Road are care homes for adult, male clients with forensic backgrounds and complex mental health needs. From the St Martin of Tours website [

“We work with people who have a mental illness, or a profound personality disorder, and who usually have a history of involvement with the criminal justice system. Most of our residents will have previously been detained in hospital under the Mental Health Act and some are subject to Home Office restriction orders.”

The service takes men aged between 18 and 65 years. They are resident for an average of two years, though some may stay longer. Many come to the centre after a long spell in prison or hospital and, after staying at the centre, are expected to move on to supported housing. The centre takes residents that other centres and supported housing may not have the expertise and capacity to take. Decisions about when a resident is ready to leave are made with the involvement of the resident and their care team.

Prior to the visit, LINk members undertook a training session delivered by the national mental health charity Rethink. The schedule of questions used in previous Enter and View visits to care homes for older people was substantially changed to make it more appropriate to the needs of residents with complex mental health needs.

1. Methodology: How we carried out the research

Building on the work of previous years, the LINk decided to focus our visits onresidents’ access to primary care, nutrition and activities. LINk members spoke to staff and residents about these topics. Five people from LINk visited the service on 12 November between 4.00pm and 6.30pm. The LINk Enter and View visitors were given personal alarms while we were interviewing residents.

1. Findings
2. General observations

The building was clean and inviting and the atmosphere seemed relaxed with residents coming and going and talking to each other. Books and newspapers were available and timetables and posters for activities were displayed around the home. There was a garden and a number of shared kitchens for residents, since they are responsible for buying and cooking their own meals.There are broadband connection points in the communal areas of both projects. The provider is currently looking into the best mechanism for enabling internet access with relevant security considerations. This will be addressed in early 2013.The staff were welcoming and friendly and treated residentscourteously.

3.2Interviews with residents

Residents who were home at the time of the visit were invited to speak to LINk members if they wished and we spoke to eight residents. Interviews took place in communal areas without staff being present.

Living in the home

When asked ‘Do you like living here?’ residents responded that they did. Residents felt able to talk to staff easily and that they were respected by staff.

“All staff have empathy.” Resident 6.

“Staff understand what I feel.” Resident 7.

Residents took part in a variety of activities. These ranged from those organised throughSt Martins such as cooking classes and cinema trips, to more independent activities such as attendance at college courses, making library visits, using local internet cafes and reading and watching television or DVDs. Residents knew what activities were taking place from information displayed in the centre and from conversations with staff.

Residents found the cooking facilities in the kitchen satisfactory and said that the range of utensils was good. Residents were encouraged to cook their own food – the centre’s activities included healthy eating – but many also chose to buy a takeaway from a nearby café.

Most residents had their own mobile phonesfor communicating with friends or family.

3.3Interviews with staff

The Enter and View team met the New North Road Centre Manager, the Deputy Manager of Wilton Villas and the Activities Co-ordinator (who works across both centres).

Both centres have a manager and deputy manager. Wilton Villas has five Project Workers, five Support Workers and two night workers. New North Road has three Project Workers, five Support Workers and two night workers. A manager is always on site during the week and there is always a manager on call if not on site. There are usually four or five staff at each centre at any one time with five support workers covering Monday to Sunday and a team of permanent night staff. Staff turnover was fairly low, with most staff staying two to three years on average. Shifts are seven and a half hours.

On average staff attend 12 days of training per year and managers have 6 management training days.All service users have a named keyworker, who is usually a Project Worker and they will meet formally with this keyworker at least once per week to discuss aspects of their care plan and on-going support.

Residents have their own rooms, furnished with a bed, fridge, wardrobe and lamp. There are shared bathrooms, shared kitchens and shared laundry rooms between each six residents. Due to conservation restrictions the building cannot be adapted to create en-suite rooms.

Staff explained that residents tended to register with local GP services at Elizabeth Avenue Practice or River Place. Staff at the centre work with patients to help them remember to attend appointments, or suggest appointments if a resident is thought likely to benefit from medical help.

There are a variety of referral sources, which might include CMHT’s or their replacements, in any of a number of boroughs across London. The service also receives referrals directly form secure psychiatric hospitals and, in the case of New North Road, the North London Forensic Service makes a significant proportion of the referrals. Residents have their own social workers and key workers to support them. As with all members of the community, residents can access local dental, optical and other primary care services as needed.

Residents are free to come and go from the centre and are allowed to drink alcoholand smoke in their own room. New residents sign up to the centre’s policies when they join. One of these policies is that the staff are interventionist so that, for example, if they were concerned that someone was drinking too much, they would intervene. Visitors are allowed until 11pm.

There is no evening curfew, though some residents may have restrictions placed on them by the Courts. Any such restriction would be reflected in their care plan. Staff aim to see every resident on their shift and will let colleagues know if anyone had not been seen. If a resident has not been seen for 24 hours the centre would try to contact them or implement their missing persons policy. This includes reporting the absence of the resident to the police.

The activities co-ordinator works across Wilton Villas and New North Road and a number of other St Martin of Tours services. Residents choose their activities with the support of the project workers and social workers. The centre is self-catering and project workers may support residents with shopping and cooking if needed. Cooking classes include considerations for preparing meals suitable for people managing their Diabetes. The activities co-ordinator also arranges healthy cooking workshopsand the residents run a cooking workshop on Fridays. The activities co-ordinator works with local colleges and centres to find relevant educational opportunities for residents so that when they feel ready, they can participate. Football games in a local park are arranged on Fridays, there are museum visits, gardening in a local square and it seemed that the Activities Co-ordinator had helped to develop positive relationships between the centre and the local community.

Most residents receive benefit payments directly into a post office or bank account and manage their funds themselves. Some residents may chose to leave their money with staff each week and follow a voluntary budgeting plan. In a small number of cases residents have an appointee, who is not a member of the project staff and this appointee, usually a social worker, will transfer the client’s funds each week to the project staff who hands it to the resident on a daily basis. The centre can support residents to access Disability Living Allowance and other benefits to which they may be entitled.

There are monthly residents' meetings chaired by staff (chair rotates). Minutes are displayed on a notice board. Staff were asked about the impact of financial cuts on services. It was suggested that the pressure on psychiatric wards may mean that people are moved more quickly than previously into centres such as Wilton Villas and New North Road. Since the client group has high support needs, they require robust support packages.

If residents are able to self-medicate, this is encouraged but at the time of the visit, only one resident was able to do this. For all other residents, the taking of medication was supervised. Staff are trained to manage any potential issues of violence and all staff carry personalalarms.

1. Summary of findings

Staff were welcoming, friendly and helpful and we observed a positive and relaxed atmosphere. It seemed that there was a good rapport and good communication between staff and the residents who were home on the day and time of our visit. There was plenty of information available to residents about activities they could take part in and support is available if needed.

1. Recommendations

On this occasion, from the information gathered during the LINk visit, LINk felt it was not necessary to make any recommendations to the service provider or commissioner.

Appendix A:Preliminary request for information

1. Residents’ access to NHS services

1. Is a GP practice linked to the home and/or do any residents have their own GP?

1. If there is a linked practice, is there a regular schedule of visits?

1. How do residents access dental care?

1. Are there visits from the community dental service?

Please state the date of the last visit.

1. Does an optician visit to check the sight of residents and provision of glasses?

1. Does the audiology service visit to test hearing and check use of hearing aids?

1. What is the home’s practice on hearing aids?

1. What provision is made for residents’ access to other NHS services such as podiatry and physiotherapy?

1. What procedures do you have to ensure pressure sores are avoided and residents skin is cared for?

1. What procedures are in place to ensure careful manual handling, for example, are slip sheets used?

2. Staff and training

1. What is the staffing structure for the home (including numbers of caring and nursing staff)?

1. Are there any staff vacancies?

1. What has been the rate of staff turnover (during the last 12 months)?

1. What are the shift times for staff at the home, including break times?

1. Is there always a manager on duty in the home at weekends?

1. Is the current manager permanent or temporary?

1. Is there a registered nurse on duty at night/weekends?

1. Does the activities co-ordinator sometimes cover for other staff on sickness or holiday (and if so how often)?

If so, how dos this affect activities offered/ taking place?

1. Who covers for the Activities Co-ordinator during holiday or sickness periods?

1. Have there been any admissions to hospital of residents in the last six months?

1. What training is available to staff and how regularly is it on offer?

(Dementia, Palliative Care, End of Life Care, Continence, NHS Islington’s Oral Health training, foot care training)

1. Are staff released for training or does this have to be taken from their annual leave entitlement?

3. Food provision and activities

The LINk will be looking at these areas on its Enter and View visit so would appreciate information on the provision of these services.

Please could you tell us about how you cater for residents.

Please could you tell us about the activities on offer, and how residents can access these.

How do residents access their own money, or their personal budgets? Can they use these funds to access other activities?

And finally, how has the recession, and any financial constraints brought on by the recession, impacted on the home?

Appendix B:Service User Questions

Questions for Interview with Residents or Carers

LINk collects people’s views on local health and social care services. Everything you say is in confidence, but a summary of the findings will be shared with the people responsible for services to help future improvements.

If there are any questions that you don’t want to answer, you don’t have to. If you change your mind about taking part you are welcome to stop at any time. Are you happy for us to start now?

1. Do you like it here / Do you like living here?

(If possible prompt for what they like and dislike about living here – is there anything you really like? Is there anything you don’t like? Do they feel this is their home?)

Activities

2.What do you do during the day?

(If possible prompt for any activities that they like and do – What did you do this morning/this afternoon? [Insert prompts here on personal activities and group activities available, include books, newspapers, pets and plants – also maybe an extra question on choice, facilities and social visits]?)

3.What do you do during the evening?

(If possible prompt for any activities that they like and do – What did you do this morning/this afternoon? [Insert prompts here on personal activities and group activities available, include books, newspapers, pets and plants – also maybe an extra question on choice]?)

4.Are there regular activities outside the home that you can take part in?

(Prompt: day trips, shopping, trips to visit friends and family)

5.Are you able to go out independently?

(Prompt: regularity?)

6. How do you find out about what activities are going on?

7.Do you have access to your own money (or personal budget – funds from the council) for visits, activities, to buy things you want?