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Inspection on 20/11/09 for Arbours Crisis Centre

Also see our care home review for Arbours Crisis Centre for more information

This is the latest available inspection report for this service, carried out on 20th November 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 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

The Crisis Centre offers a unique service for people who are experiencing mental health problems/emotional distress. The centre uses the model of a therapeutic community. There are three community meetings each week and each guest has a minimum of three sessions of psychotherapy each week with a team leader and a resident therapist. In addition, Art therapy is offered on a weekly basis along with movement therapy and yoga. The centre provides continuity of care, in that when fully staffed, there are three resident therapists who live in, and a small team of therapists who support guests, when the resident therapists have days or weekends offIndividual psychotherapy is with the same therapists throughout the guest’s stay and can be continued after they leave if this is appropriate for them. The house provided is homely and welcoming, and guests are encouraged to use local facilities, for which the home is extremely well sited. Guests are encouraged to be as independent as possible and to take responsibility for themselves. At the same time, a high level of emotional support, intensive psychotherapy, good food and a comfortable homely environment is provided. Guests say the service helps them and many have been able to benefit from the support offered. During holiday periods from the centre programme, guests are able to take advantage of recreational activities of their choice, with staff support. A questionnaires received from a healthcare professional indicated that the service is highly rated for ‘responding to changing needs, understanding and containing challenging behaviour.’

What has improved since the last inspection?

Significant improvements had been made in the recording and administration of medication to guests at the centre, to ensure that their medication needs are met safely. Improvements had also been made with regard to the format and content of care plans and risk assessments, and fire precautions within the service. Staff training in medication administration and safeguarding vulnerable adults had been implemented across the team.

What the care home could do better:

The safeguarding adults and complaints policies for the centre must be reviewed to provide more detailed information, so that all parties are clear about action to be taken, for the support and protection of guests and staff. A policy and procedures should also be available for working with people who self harm to ensure consistent support for guests with self harming behaviour. Two references must be kept on file for each staff member working within the home to evidence that guests are protected by robust recruitment practicesAll relevant staff must be provided with training in health and safety, food hygiene, fire safety and first aid to ensure the safety of guests within the home. Regular monthly visits must be carried out on behalf of the provider organisation, and results of quality assurance audits must be sent to the Care Quality Commission to ensure that the quality of services are monitored. The fire risk assessment must be reviewed at least six-monthly.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Arbours Crisis Centre Arbours Crisis Centre 41a Weston Park Hornsey London N8 9SY Lead Inspector Susan Shamash Unannounced Inspection 20th November 2009 12:00 Arbours Crisis Centre DS0000027800.V378156.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 Arbours Crisis Centre DS0000027800.V378156.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 Older People and 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. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Arbours Crisis Centre Address Arbours Crisis Centre 41a Weston Park Hornsey London N8 9SY 020 8340 8125 020 8342 8849 info@arbourscentre.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Arbours Housing Association Ltd Manager post vacant Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th March 2009 Brief Description of the Service: The Arbours Crisis Centre is registered as a care home for six people with mental health problems. The Crisis Centre is part of a range of services offered by the Arbours Association, a registered charity that describes in its core mission statement that it offers personal, psychotherapeutic support and places to live, outside of mental hospital, for people in emotional distress. The centre is a large house on four floors with the six single bedrooms for the guests on the first, second and third floors. The fourth floor is used by resident therapists, who live at the centre. There are two lounges and a kitchen diner on the ground floor. The house has a large garden with a studio which is used for a range of activities, such as art and movement therapy. The house is situated in the heart of Crouch End, North London. There is easy access to all local amenities. The stated aim of the centre is that it provides intensive personal, psychotherapeutic intervention and support within the context of a noninstitutional therapeutic community environment. The fee for living at the Crisis Centre is £1965 per week as at November 2009, however fees are currently under review. Following Inspecting for Better Lives, the provider must make information available about the service, including inspection reports, to service users and other stakeholders. At the time of this inspection there were three women living at the Crisis Centre. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star – good service. This means the people who use this service experience good quality outcomes. This inspection took place on a Friday afternoon. I had the opportunity to speak with two guests, two resident therapists, and an assistant director during the visit, however the centre manager was not available on the day of the inspection. I therefore obtained further information from her, following the visit, by telephone and email. I conducted a tour of the building, and inspected three care plans, risk assessments and other records relating to the guests to see if their needs had been assessed and were being met. I also inspected staff files to ensure that they had been properly vetted, trained and supervised. Medication management and administration and health and safety records relating to the home were also inspected. Completed feedback surveys were received from two staff, one healthcare professional and one service user. Information provided in these questionnaires was also taken into account alongside the Annual Quality Assurance Assessment completed by the service manager. There were three guests living at the Crisis Centre at the time of this inspection, alongside two resident therapists. Arbours refer to people who are living at the Crisis Centre as guests and this is the term used throughout this report. What the service does well: The Crisis Centre offers a unique service for people who are experiencing mental health problems/emotional distress. The centre uses the model of a therapeutic community. There are three community meetings each week and each guest has a minimum of three sessions of psychotherapy each week with a team leader and a resident therapist. In addition, Art therapy is offered on a weekly basis along with movement therapy and yoga. The centre provides continuity of care, in that when fully staffed, there are three resident therapists who live in, and a small team of therapists who support guests, when the resident therapists have days or weekends off. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 6 Individual psychotherapy is with the same therapists throughout the guest’s stay and can be continued after they leave if this is appropriate for them. The house provided is homely and welcoming, and guests are encouraged to use local facilities, for which the home is extremely well sited. Guests are encouraged to be as independent as possible and to take responsibility for themselves. At the same time, a high level of emotional support, intensive psychotherapy, good food and a comfortable homely environment is provided. Guests say the service helps them and many have been able to benefit from the support offered. During holiday periods from the centre programme, guests are able to take advantage of recreational activities of their choice, with staff support. A questionnaires received from a healthcare professional indicated that the service is highly rated for ‘responding to changing needs, understanding and containing challenging behaviour.’ What has improved since the last inspection? What they could do better: The safeguarding adults and complaints policies for the centre must be reviewed to provide more detailed information, so that all parties are clear about action to be taken, for the support and protection of guests and staff. A policy and procedures should also be available for working with people who self harm to ensure consistent support for guests with self harming behaviour. Two references must be kept on file for each staff member working within the home to evidence that guests are protected by robust recruitment practices. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 7 All relevant staff must be provided with training in health and safety, food hygiene, fire safety and first aid to ensure the safety of guests within the home. Regular monthly visits must be carried out on behalf of the provider organisation, and results of quality assurance audits must be sent to the Care Quality Commission to ensure that the quality of services are monitored. The fire risk assessment must be reviewed at least six-monthly. 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. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective guests have enough information about the service to help them decide whether it is right for them. They have the opportunity to visit, and their needs are assessed before they are offered a place at the centre. EVIDENCE: Discussion with guests and the manager indicated that admissions to the Crisis Centre are clearly planned. Guests are encouraged to visit the centre on a number of occasions before making their decision to move in. A detailed admission and consultation procedure is available requiring detailed information to be received and an assessment to be undertaken before any guest moves into the Crisis Centre. Inspection of the assessment documents for the three guests, indicated that the quality of assessment information was Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 10 appropriate. There was written information about each guest’s needs completed before they moved into the centre including records of consultation with guests, their representatives, and healthcare professionals involved with them in order to get a complete picture of their needs. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Guests are consulted on all aspects of life at the centre and are supported to take risks as part of an independent lifestyle. Improvements have been to care plans and risk assessment to ensure that people’s holistic needs are addressed. EVIDENCE: The care plans and risk assessments for the three guests staying at the centre were inspected. At the previous inspection it was required that the format be improved to include all aspects of people’s needs including needs and wishes that do not fall into the mental/emotional health area. The mental/emotional Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 12 health needs of guests continue to be addressed in a comprehensive and detailed way. In addition care plans now covered physical health, cultural, religious, social and other needs. The format has thus been improved to address people’s holistic needs. However one guest’s care plan had not been reviewed since February 2009, and a requirement is therefore made that all guest’s care plans be reviewed at least six-monthly so that these remain current. The manager advised that a proposed review of this person’s care plan was due to take place in January 2010. Discussion with the staff members and the guest indicated that information recorded within the care plan was generally up to date. Staff spoken to were aware of guests’ varied needs including religious and cultural needs and this information is recorded as appropriate. Each support plan was individualised, incorporating a range of therapeutic approaches to suit each resident including team, group, art, milieu and movement therapy. Written documentation also included consultation with guests including their signatures where this was agreed. Risk assessments had also been developed, with an ongoing review process charting the assessment of risk for each resident on a daily basis. Information provided in the Annual Quality Assurance Assessment indicates that the ethos of the centre is to encourage healthy risk taking or containment and safety depending on the emotional state of each guest. It is also noted that there may sometimes be a conflict in balancing the stated needs and choices of each resident with the psychoanalytic psychotherapeutic process, and staff spoken to also commented on this. One guest advised that they received the right kind of support when they harmed themselves or felt suicidal. Another guest spoken to was not feeling as positive about how the support provided was helping them, but advised that staff were always available when needed, and provided a high level of support. Guests advised that they were encouraged to be as independent as possible within the expectations that they attend the planned therapy sessions and house meetings. They advised that they were consulted on all aspects of life in the centre at house meetings and were able make decisions and choices, particularly about decor and equipment for the house, which they appreciated. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 and 17. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 14 People staying at the centre are offered a unique opportunity for intensive personal development. They are encouraged to live a healthy lifestyle with good food, appropriate support, opportunities to follow their personal interests and maintain and develop their relationships. People are treated with respect and encouraged to take responsibility for themselves. EVIDENCE: Guests attend a minimum of three therapy meetings at the centre each week with their team, which comprises a psychotherapist and a resident therapist. Resident therapists live in the centre and are training to be psychotherapists. Guests may also have more therapy sessions each week if needed including family therapy sessions. In addition guests attend a number of groups including “house” meetings, art therapy, movement therapy and yoga sessions. One of the group meetings is a creative activity where guests choose what to do. Guests spoken to were generally positive about the activities provided, particularly movement therapy, art therapy, the creative group and yoga. They also advised that they had two-week breaks over Christmas, Easter and the summer, during which they would engage in social activities with the resident therapists and other guests. One guest showed me the programme of activities that had been agreed over the summer break, including trips out to exhibitions, shows, and meals out. Both guests confirmed that resident therapists were generally free to go out with them for walks or for a coffee in a local café when requested. However there were no clear records of the choices of leisure activities available to guests, and this is recommended, to evidence that guests are given a choice of stimulating activities in which to engage. Guests advised that they were expected to participate in all the structured sessions but could choose not to. They spoke of a conflict between wanting more structure and organised activities, but being aware that time to think and spend unstructured time in the house is an important part of the therapeutic programme. Guests confirmed that they made their own choices about how and when they have contact with family and friends, and resident therapists support them with family contact as needed, for example going with a guest to visit relatives where the guest asks for this support. Guests can retain an independent social life outside the centre as long as this does not conflict with the therapy sessions they are expected to attend. Smoking is allowed only in the conservatory so that it does not impinge on the rights of guests and staff to live in a smoke free environment. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 15 Guests are fully involved in decisions regarding running the centre and have a housekeeping meeting weekly. Cooking is shared, with support available from the resident therapists. Guests generally eat as a group with the resident therapists, but do not have to. They advised that they were able to choose what they want to eat. At the time of the inspection I observed one guest preparing lunch for the group. The home was well stocked with fresh, dried and tinned ingredients including fruit and vegetables. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Guests receive a good level of personal support with their emotional and physical health needs. Improvements in medication storage and administration practices protect them from risk of harm due to medication errors. EVIDENCE: Guests’ health needs were recorded in their care plans, and I had the opportunity to discuss these with staff and guests. Guests confirmed that staff supported them with their physical health needs including injuries relating to self harm. Resident therapists also accompany guests to hospital where needed and to GP appointments. Guests said they received the support they Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 17 needed with accessing healthcare professionals, and there were records made of medical appointments including the outcome. In the Annual Quality Assurance Assessment for the service, plans for improvement included introducing regular complementary therapies such as aromatherapy, Indian head massage, and reflexology. Apparently such treatments had been requested by guests over the summer, and had been provided. Due to the high risk of misuse of medication and overdose in the crisis centre compared with other registered care homes, there is a need for extra vigilance in the area of medication. At the previous key inspection, there were a significant number of concerns about medication indicating unsafe medication practices, following which a Statutory Requirement Notice (SRN) was served, and a pharmacy inspector visited the home on three occasions. At the inspection on 22nd May 2009, the service was found to be compliant with the SRN, however a requirement was made regarding the legibility of duplicated records, and recommendations were made regarding recording the site of pain when administering painkilling medicines, and improving the effectiveness of the service’s internal audit processes. The home utilises a monitored dosage system (MDS) together with medication administration record (MAR) charts with printed details of dispensed pharmaceuticals supplied by the pharmacy. There was a record of receipt of medication into the home, and any additions or changes to the charts had been endorsed with the date and signed initials of the authorised person making this entry. An appropriate record for the disposal of pharmaceuticals was also in place, and as required at the previous inspection, this was found to be legible. Homely remedies for general use, continue to be recorded in a separate book, however they are also recorded on the MAR chart for each guest. The number of different painkillers available has been reduced, as required, and as recommended the site of pain, which leads to a request for such medication, was being recorded in each instance. There was an improvement in the recording of directions for administration of prescribed medicines, so that they were no longer recorded as ‘as required’ or ‘as directed’ but included information about minimum interval between doses, maximum dosage within a time period etc. Medication policies and procedures had been updated to include CQC guidance and the guidance of the Royal Pharmaceutical Society. All relevant staff had undertaken medication training as appropriate, and regular audits were being Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 18 undertaken regarding the administration of medication to ensure that there are no errors. This audit now includes a count of the number of tablets at the beginning and end of each week, to ensure that there are no tablets unaccounted for. There were no Controlled Drugs (CD) currently prescribed for users of the service, although a CD cupboard was provided within the medicines cupboard. There were no medicines requiring cold storage, however staff advised that should this be needed, they would use a labelled and locked box in a small spare fridge currently available in the home. Temperature monitoring was being undertaken using a maximum/minimum thermometer to evidence temperatures are within the licensed storage requirements. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Guests feel that their views are listened to and acted upon and they know how to make a complaint if they need to. They benefit from a team of staff who have experience in working with people who self harm. However the centre needs clearer communication and safeguarding procedures, in order to protect the wellbeing of guests. EVIDENCE: There is a complaint procedure which guests are familiar with. It is part of the culture of the centre to consult with guests regularly about all issues of running the centre and guests said that they are listened to and their suggestions are generally acted upon. Guests also considered that they received the right kind of support with self harming, and staff were confident about working with this behaviour. At the previous inspection it was recommended that a clear policy and procedures for working with self harming behaviour be produced. The management advised that this was not yet available, but was due to be completed shortly. This Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 20 remains recommended, in order to promote consistency in the interests of guests’ welfare. One guest advised that they had experienced some problems regarding communication at the higher management levels of the service, in addressing a concern raised. Inspection of the complaints policy showed that there was room for improvement of this policy to include more detail about what complainants may expect, including timescales for the response, lines of communication and when there is a need to notify an external agency etc. to ensure that all parties are clear about the procedures to follow. As recommended the manager had contacted the local safeguarding coordinator for information, and advised that this had been very informative. Inspection of staff files showed that all members of the staff team had undertaken relevant training in safeguarding adults. The centre’s safeguarding policy had been updated since the previous inspection, however it did not include sufficient information regarding procedures to be followed, relying instead on the local authority policy and procedures. There have been one safeguarding issue since the last inspection, and the Care Quality Commission had been notified as appropriate. However the investigation highlighted a lack of clarity in the centre’s current safeguarding policies, with regards to relevant points of contact, people who need to be notified, limits of confidentiality, transparency and clear lines of communication. A requirement is made accordingly for the support and protection of guests and staff. Discussion with the management of the service, and information provided in the Annual Quality Assurance Assessment indicated that there was already an awareness of the improvements that needed to be made in this area. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Guests live in a clean, comfortable and homely environment where they are involved in planning improvements. EVIDENCE: I conducted a tour of the home including communal rooms and two guests’ rooms with their permission, and discussed the environment with two guests, and the resident therapists. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 22 Guests have use of a large lounge, kitchen diner and conservatory. There is a studio building in the garden which is for art therapy, creative groups and yoga. Guests said they were happy with the facilities provided. The house appeared to be clean, homely and suitably furnished and decorated. Guests and resident therapists were happy with the environment, and advised that maintenance issues were addressed swiftly where these arose, and that their rooms were comfortable. Guests advised that all equipment was working well at the time of the inspection, and that they were involved in making decisions about purchases for the home. They also advised that they are consulted on what improvements should be made to the house. There was a reasonable standard of cleanliness in the kitchen, bathrooms and toilets. The manager advised that a new housekeeper had been employed in the last year, and guests confirmed that they were satisfied with the levels of cleanliness within the home. There is a proposed programme for redecoration of particular areas of the home over the coming year. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Guests are supported by sufficient numbers of staff but are not fully protected by a consistent safe recruitment practice to ensure staff are vetted for suitability before coming to the centre. EVIDENCE: At the time of the inspection there were two resident therapists living at the home to support guests, with assistance from a team of other therapists. One resident therapist had left shortly before the day of the inspection, and a third resident therapist was due to be recruited to live and work at the centre. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 24 During the day and evening there are always two resident therapists in the house and available to guests. The centre management advised that the staff team has assessed that there was no current need to have anyone awake at night to support guests. A risk assessment had been conducted indicating that the current arrangements whereby guests wake the resident therapists if they need help during the night is sufficient for their needs. Staff advised that the risk assessments with regard to this area are regularly reviewed, and ongoing risk assessments were available for inspection. Guests spoken to advised that they had been consulted regarding the risk of suicide/self harm at night, and were satisfied with the current arrangements. If they do not feel comfortable going to wake somebody up for help, they can send them a text message and the staff will come downstairs to them. Staff advised that if they were awoken at night, extra staff support could be provided the following day. Nine staff files were inspected on this occasion, including both resident therapists, and the centre manager. Inspection of recruitment records indicated that appropriate criminal records bureau (CRB) disclosures had been obtained before each staff member being allowed to start work which indicates a safe recruitment practice. However although the majority of staff files included two written references, there were some gaps in these records including only one reference on file for three staff members. The management advised that these records were available in a separate location, and copies of these references would be provided for the home’s files. Staff spoken to confirmed that they had received induction training prior to working at the home, and records were available to confirm this. Certificates were also available to confirm staff training in safeguarding adults, and medication administration. Only one staff member (among the nine staff files checked) had undertaken food hygiene training and first aid training. Therefore training records indicated insufficient training in mandatory areas including health and safety, food hygiene, fire safety and first aid. Whilst it is understood that this is partially due to the staff turnover within the centre, a requirement is made accordingly. The management advised that they are in the process of booking further training courses for staff within the home. One resident therapist was spoken to at greater length, and advised that they receive regular clinical supervision about their work and attend regular meetings to discuss their work with guests, with team leaders available to advise them on a frequent basis both through their meetings and by an on call rota system. They are also provided with relevant clinical training outside of the centre. Discussion with management and information provided in the Annual Quality Assurance Assessment indicated that there were plans to improve the quality Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 25 of supervision relating to the running of the centre, and implement regular staff appraisals. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, and 42. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Guests benefit from a service which asks for and respects their views. However improved quality assurance procedures are needed to ensure that the service continues to develop in the best interests of guests. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 27 EVIDENCE: Since the previous inspection the director for the service has left employment with the Centre. Two assistant directors are currently covering this role, and have advised that the management structure of the service is currently under review in order to reflect ongoing changes in the field of mental health and the economic climate. There had not been a registered manager for the Crisis Centre for the last few years, and the current manager is due to leave employment with the service in January. Recruitment is currently underway for a new centre manager, who would be expected to apply for registration with the Care Quality Commission. The current manager advised that she had been provided with regular supervision from the director and this was recorded as appropriate. Regulation 26 monthly reports on the centre were undertaken in the last year, but there is currently no staff member responsible for undertaking these visits. A requirement is made accordingly. Guests said that they were generally satisfied with the running of the centre and thought that a good service was provided which was helping them. They felt they were consulted and supported well. However one person indicated that there was room for improvement regarding communication about their concerns. There are weekly clinical meetings to discuss guests, and all staff including the manager, therapist team leaders and resident therapists are expected to attend these so there is regular communication taking place. There is always a team leader or manager on call available to the resident therapists if they need advice. The manager advised that they had also introduced weekly administrative meetings, to address specific issues of concern relating to the service. The management advised that they have introduced the CORE (Clinical Outcome Research and Evaluation) system for all new guests, to evaluate the efficacy of the work of the centre charting a guest’s stay from the assessment, half way through the stay, at the end and after the stay, and the developments that have taken place. For current guests they will also be revising the centre’s post-stay questionnaire and this will be sent out to all guests who were at the Crisis Centre in the last two years. A follow-up questionnaire will be sent out three months, six months and twelve months after a guest’s stay. They also advised that they are in the process of recruiting a suitable person or organisation to carry out a twice yearly audit of the Centre. The results of at least annual quality assurance audits must be sent to the Care Quality Commission. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 28 I inspected a range of health and safety records. As required at the previous inspection staff were checking fire doors and fire exits as part of their health and safety checks. The fire risk assessment that was available at the time of the inspection had not been reviewed since 2007. The manager advised that a more recent review had been undertaken and agreed to send a copy of this to the Care Quality Commission. The fire alarms has been tested on a weekly basis, and were being serviced regularly as appropriate. Regular fire drills were also being held at the home. A current electrical installation certificate was available for the home, and portable electrical appliances had been tested within the last year. However the gas safety certificate was due to be carried out. Incidents required to be reported to the Commission are being regularly reported. risk assessment on hazardous substances in the house such as bleach needs to be carried out and risks to guests minimised. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 29 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 Standard No 1 2 3 4 5 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 2 40 X 41 X 42 3 43 X X 3 X 3 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Arbours Crisis Centre Score 3 3 3 X DS0000027800.V378156.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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(2) Requirement Timescale for action 22/01/10 2. YA23 13(6) 3. YA34 17 Sched 4 The registered person must ensure that guest’s care plans are reviewed at least six-monthly so that these remain current and facilitate people’s needs being met proactively, and in accordance with their preferences. The registered person must 08/01/10 ensure that the centre’s policy and procedures for addressing complaints, and for safeguarding vulnerable adults include details of how issues will be addressed, what complainants may expect, timescales, points of contact, lines of accountability, transparency and communication, and duties to notify the Care Quality Commission and the placing/local authorities, medical professionals and police, where relevant, for the support and protection of guests and staff. The registered person must 18/12/09 ensure that two references are kept on file for each staff member working within the home, to evidence that guests are protected by robust recruitment practices. DS0000027800.V378156.R01.S.doc Version 5.2 Arbours Crisis Centre Page 31 4. YA35 18(1ci) 5. YA39 24 6. YA42 13(4) The registered person must ensure that all relevant staff are provided with training in health and safety, food hygiene, fire safety and first aid to ensure the safety of guests within the home. The registered person must ensure that regulation 26 visits are carried out on behalf of the provider organisation, and send reports of these visits and the results of at least annual quality assurance audits to the Care Quality Commission to ensure that the quality of services are monitored. The registered person must ensure that the fire risk assessment is reviewed at least six-monthly, and the gas certificate includes an inspection of the boiler and cooker within the home, for the protection of people living and working at the home. 12/03/10 12/02/10 25/12/09 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 YA12 Good Practice Recommendations It is recommended that records be maintained to evidence that guests are provided with a range of choices of leisure activities in which to engage, to ensure that they are encouraged to feel valued and fulfilled. It remains recommended that a policy and procedures for working with people who self harm is made available to staff, to advise them how to consistently support guests with self harming behaviour. It is recommended that all staff working with guests undergo regular appraisals regarding their performance, to ensure that they are encouraged to develop their roles within the home, and identified training needs can be addressed. DS0000027800.V378156.R01.S.doc Version 5.2 Page 32 2. YA23 3. YA36 Arbours Crisis Centre Commission for Social Care Inspection Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.london@cqc.org.uk Web: www.cqc.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. Arbours Crisis Centre DS0000027800.V378156.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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