CARE HOME ADULTS 18-65
Arbours Crisis Centre Arbours Crisis Centre 41a Weston Park Hornsey London N8 9SY Lead Inspector
Jackie Izzard Unannounced Inspection 20th October 2005 09:45 Arbours Crisis Centre DS0000027800.V252176.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 Arbours Crisis Centre DS0000027800.V252176.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. Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 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 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 Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd May 2005 Brief Description of the Service: The Arbours Crisis Centre is registered as a care home with nursing. The centre is registered to accommodate six adults. 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 three lounges and a kitchen diner on the ground floor. The house has a large well maintained garden with a studio which is used for a range of activities, such as art 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. Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on 20 October 2005 at 9.45am and lasted four and a half hours. The inspection was unannounced, so nobody at Arbours knew the inspector was coming. The inspector met the three resident therapists, the manager of the centre, the deputy director of the Arbours Association and five of the six people currently staying at the centre. People staying at the Crisis Centre are referred to as guests, so this is the term used in this report. The inspector looked at records kept in the centre and followed up the requirements made at the previous inspection in May 2005 to see if Arbours had carried out the things they were asked to do at that inspection. 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 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 there are three resident therapists who live in and a small team of therapists who stay at the centre at weekends when the residents therapists have weekends off. 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 is attractive with good-quality furniture, and guests choose how they decorate their own rooms and also choose the decor for communal areas. The house is homely and welcoming. An attractive and well maintained garden is provided, complete with pond and a wooden studio building which can be used for individual and group activities. Guests are encouraged to be as independent as possible and to take responsibility for themselves. At the same time, a high level of emotional
Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 6 support, intensive psychotherapy, good food and a homely environment is provided. What has improved since the last inspection? What they could do better:
A number of requirements made at the last inspection have not yet been met and have been restated in this report, with a new timescale for compliance. In the ‘Timescale for Action’ column, the date in ordinary type relates to the timescale given at the last inspection. The date in bold type relates to the new timescale. Further information about unmet requirements can be found in the relevant standard. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. The Arbours Association need to ensure they have taken out proper checks on any new therapists before they start to work at the Crisis Centre. A requirement was made at the last inspection in May 2005 to ensure they obtain a satisfactory CRB (Criminal Records Bureau) check before allowing someone to begin work at the Centre. Although they agreed to this, another resident therapist has been employed since that inspection before Arbours had taken out a new CRB check on that person. Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 7 Fire safety is an area which needs improvement in the Crisis Centre. Records show one emergency light had been broken for a year and two others were not working and an immediate requirement notice was issued on this matter. This notice specifies a time by which the lights must be working. The centre also needs to urgently develop a fire risk assessment, identifying the risks of fire and what action is being taken to prevent a fire, and a fire emergency plan. Another immediate requirement notice was issued on this matter. A third immediate requirement was issued requiring the Arbours Association to ensure a care plan and risk assessment is developed with each guest by 30 November as three of the four files inspected had neither of these. Care plans at the Crisis Centre are currently of a very basic standard and do not reflect the good work carried out with guests. A new manager for the Crisis Centre needs to be recruited by Arbours and registered by the CSCI. 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. Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 8 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 Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 9 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): 2, 4, 5 Prospective guests are fully informed about the services offered at the Crisis Centre and what will be expected of them, before they move into the centre. Admissions to the centre are carefully planned in order to meet the guests needs. People are fully aware that they will be expected to engage in the therapeutic programme and have a clear contract of the terms and conditions of their stay. The Arbours Association need to consider how evidence that an assessment of a prospective guest’s individual needs has been carried out if this assessment is not kept on their personal file. EVIDENCE: Admissions to the Crisis Centre are well planned. The admissions procedure is detailed and clear. Before moving into the centre, the guests will visit the centre. Prospective guests have the opportunity to visit the centre on a number of occasions before making their decision to move in. Guests are given a contract with the terms and conditions of their stay which they are required to sign. The inspector saw a copy of such a contract in one guest’s file. Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 10 There was no evidence in three guests’ files that an assessment of their needs had been carried out before their admission to the centre. All three had moved into the Centre since the last inspection five months ago. The inspector was assured that written records of the meetings with prospective guests and an assessment had been recorded but were not available for inspection. . Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 11 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, 8, 9 Care plans are of a basic standard and three guests did not have one, so care plans do not reflect the quality of work at the Crisis Centre. Risk assessments for guests need to be carried out prior to admission or at an early stage of their stay at the Centre, but three of the guests had no risk assessment at the times of this inspection. All guests would benefit from an assessment of risks to their safety. Guests are consulted and fully involved in all aspects of life at the centre. EVIDENCE: Of the four guests’ files seen, three had no care plan or risk assessment. One had a basic plan, which did not meet National Minimum Standards and did not address the person’s global needs. The manager has devised a good quality care plan format but this has not been implemented. The blank sheets were in the guests’ files. The inspector is aware that good work is taking place in the Crisis Centre with guests but this is not reflected in the quality of care plans and records in the guests’ files.
Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 12 For the three newest guests there was no risk assessment available to see what risks had been identified to their safety and wellbeing and that of others in the Centre. Guests are involved in all aspects of the daily life at the Centre. They choose the weekly menu and when or whether they will cook for the group that week. Guests choose the décor for their bedrooms and decorate it themselves if they want to. Guests have the choice of becoming involved in the decorating of communal rooms. Guests are aware of the therapy timetable. There is a meeting once a week to discuss and plan housekeeping matters such as cleaning, the cooking rota and other practical issues. Since the last inspection, guests have been consulted about whether they want locks in their bedroom doors and have been supplied with these. Guests choose whether or not to participate in group activities and therapy. Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 13 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): 17 People staying at the Crisis Centre are offered a unique opportunity for intensive personal development. They are encouraged to live a good quality lifestyle with good food, and support to follow their personal interests and to maintain and develop their relationships. People are treated with respect and encouraged to take responsibility for themselves. EVIDENCE: All the above standards were assessed as being met at the last inspection five months ago so have not been reassessed at this inspection. Further information is available in the inspection report for 23 May 2005. The inspector was invited to eat lunch with guests and resident therapists and was able to confirm that a high quality of food continues to be served. Guests eat as a group. Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 14 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): 20 Guests are protected by the Centre’s policy and procedures regarding medication. They are able to control their own medication if they wish to. EVIDENCE: The manager was able to explain the centre’s procedures regarding medication and the inspector looked at the medication cabinet and records. The manager dispenses medication into dosette boxes on a weekly basis and then they are checked by the local pharmacist. One guest looks after all her own medication and another self medicates on a daily basis. There were some gaps in a guest’s medication records where the manager was able to explain that the guest had taken responsibility for her own medication. Medication was stored securely and safely. Arbours Crisis Centre DS0000027800.V252176.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): 22 Guests’ views are listened to and there is clear written guidance on how they can make a complaint. Due to the nature of the crisis centre and the people who stay there, it is not possible or appropriate to protect people from self harm, but any self harming behaviour is addressed by therapists in a consistent and planned way. People receive medical and emotional support if they harm themselves. EVIDENCE: There is a clear complaints procedure if a guest wishes to make a formal complaint. There is opportunity to air their views and grievances at the house meetings three times a week. The complaints procedure was inspected in May 2005 and found to meet the required standard. The manager confirmed that the procedure remains the same as at that time. There have been no formal complaints in the last year. There have been no adult protection investigations regarding anyone staying at the centre. The inspector discussed self harm with the nurse manager at the previous inspection who said that the therapists work together to try and ensure that self harm is dealt with in a consistent way by the team. She said that the approach to self harming behaviour is discussed regularly and evaluated. Incidents of self harm have been properly reported to the Commission for Social Care Inspection and there have been none since May 2005. Medical attention is sought appropriately and the person’s emotional needs discussed by the team to plan how best to help them. A requirement is made at the back of this report regarding risk assessments. The CSCI would
Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 16 expect self harm to be addressed in guests’ risk assessments if this is an issue for them, by 30 November 2005. Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 17 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): 30 The Crisis Centre is clean and hygienic and the guests benefit from staying in a homely, comfortable and attractive environment with a choice of spaces to spend private time in or be in the company of others. EVIDENCE: At the last inspection, standards 24, 25, 26, 27 and 28 were assessed as being met. On this occasion standard 30 was assessed. In addition, fire safety was addressed and this is recorded under standard 42 of this report. Guests have been given locks on their bedroom doors since the last inspection to give them more privacy. One guest told the inspector s/he was pleased to have a lock on his/her bedroom door. Communal rooms were seen and the standard of cleanliness was observed to be very good. Arbours Crisis Centre DS0000027800.V252176.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): 34 Guests are not always protected by the centre’s recruitment practice in that staff have been allowed to start work at the centre before a Criminal Records Bureau check had been received by Arbours. EVIDENCE: As five of the above standards were assessed at the last inspection, only the standard regarding staff recruitment was assessed on this occasion. This was because requirements were made on this area at the last inspection. Since the last inspection, Arbours have sent the CSCI copies of CRB disclosures for staff who did not have these available in the centre at the last inspection. A member of staff has been employed before Arbours have received her CRB enhanced disclosure or POVA check. This is despite a requirement made at the last inspection and Arbours agreeing that this would not happen. An immediate requirement was issued regarding this issue. The inspector also explained again to the manager, deputy director and three resident therapists that CRB disclosures are not currently portable so Arbours have to obtain a new one for any person they intend to employ and the person may not start work until at least the POVA first check (a check of the list of people who
Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 19 should not be employed to work with vulnerable adults) has been received. An immediate requirement is made on this issue at the back of this report. Arbours Crisis Centre DS0000027800.V252176.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): 37, 39 ,42 It was not possible to form a judgement regarding the management of the Centre as the manager is leaving, nor the quality assurance system as this is still in draft form. Some improvements need to be made in the area of fire safety to ensure guests are fully protected against the risk of fire. EVIDENCE: A requirement for an application to tbe made to the CSCI to register a manager for the Crisis Centre is restated. The current manager has not applied and she informed the inspector that she was leaving her post in October. A requirement to make the Centre’s quality assurance policy and annual development plan available for inspection is restated. The manager gave the inspector a copy during this inspection but this was still in draft form. Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 21 This inspection focussed on fire safety within the Crisis Centre. Fire records were inspected. The fire alarm call pints are tested on a weekly basis and recorded as required. Arbours employ a fire officer who visits the home on a monthly basis. A monthly inspection of fire escape routes is recorded. Monthly fire drills are also held and the inspector saw a random selection of the fire officer’s reports which included a record of a fire drill taking place. Records show that the fire alarm system was inspected in 2003 and 2004. It was due to be inspected before the end of 2005. Emergency lighting for use in the event of a fire in the Centre was of concern. The fire officer recorded in his monthly reports that one emergency light was broken but this had not been repaired or replaced. At the time of this inspection, three emergency lights were not working. One has been broken for one year and the other two since May 2005. An external company checked the emergency lighting on 17 October and the inspector was informed these broken lights will be replaced this week. The length of time it had taken Arbours to arrange for the replacement of these lights was discussed with the manager and two resident therapists and the inspector formed the view that staff did not know who was responsible for ensuring fire safety in the home. There was no fire risk assessment or emergency plan. An immediate requirement was issued regarding the emergency lighting and producing a fire risk assessment which must be approved by the LFEPA (London Fire and Emergency Planning Authority). Arbours Crisis Centre DS0000027800.V252176.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 2 X 3 3 Standard No 22 23 Score 3 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 X 3 1 x Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 2 X x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Arbours Crisis Centre Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 2 x DS0000027800.V252176.R01.S.doc Version 5.0 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA42 Regulation 23(4) Timescale for action The registered person must after 20/11/05 consultation with the fire authority take adequate precautions against the risk of fire. The registered person must ensure that a written fire risk assessment for the Crisis Centre is undertaken and approved by the LFEPA (Fire Brigade). A copy must be sent to the CSCI by 20/11/2005. The registered person must ensure that the emergency lighting is working by 31/10/2005. This is an immediate requirement. 19(1)(b)(i) The registered person must ensure that Arbours obtain a new CRB enhanced disclosure for any person who works at the centre on a paid or voluntary basis before that person starts work. This requirement is restated. Previous timescale of 24/05/05 not met. The registered person must obtain a POVA first check for the
DS0000027800.V252176.R01.S.doc Requirement 2 YA34 27/10/05 Arbours Crisis Centre Version 5.0 Page 24 staff member who has no current CRB and send a copy of POVA check, two references and proof of identity for this person to the CSCI. This is an immediate requirement. The registered person must ensure that each guest has a written care plan which complies with National Minimum Standard 6 and confirm to the CSCI that these have been undertaken. Individual risk assessments for each guest must also be completed by this date. This is an immediate requirement. The registered persons must ensure that an assessment of a prospective guest’s needs is carried out in consultation with them and placed on their file as evidence that their needs have been assessed. The registered person must ensure that an application is made to the CSCI to register a manager for the Crisis Centre. This requirement is restated. Previous timescale of 30/8/05 not met. The registered person must make a copy of the quality assurance policy and annual development plan available for inspection. This requirement is restated. Previous timescale of 30/8/05 not met. 3 YA6YA9 13, 15 30/11/05 4 YA2 14 01/01/06 5 YA37 8, 9 30/03/06 6 YA39 24(1)(2) 30/01/06 Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Arbours Crisis Centre DS0000027800.V252176.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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