Inspection on 23/05/05 for Arbours Crisis Centre

This inspection was carried out on 23rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Arbours Crisis Centre 05/12/08

Arbours Crisis Centre 05/07/07

Arbours Crisis Centre 18/01/07

Arbours Crisis Centre 20/10/05

Arbours Crisis Centre 26/10/04

Arbours Crisis Centre 27/04/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 ARBOURS CRISIS CENTRE 41a Weston Park Hornsey London N8 9SY Lead Inspector Jackie Izzard Announced 23 May 2005 @ 10:00 am 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 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 Stationary 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 G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Arbours Crisis Centre Address 41a Weston Park, Hornsey, London, N8 9SY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8340 8125 020 8342 8849 Dr Joseph Berke of Arbours Housing Association Ltd Vacant Post N - Care Home with Nursing 6 beds Category(ies) of MD - Mental Disorder registration, with number of places ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Arbours Crisis Centre is registered for six adults, between the ages of 18 and 65, category MD. Date of last inspection 24 October 2004 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 non-institutional therapeutic community environment. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 23 May 2005. The Arbours Association had been given four weeks notice that the inspection was going to take place on that date. The inspector stayed at the Centre for six and a half hours. The inspector followed up the requirements made at the last inspection, met with the manager and resident therapists, inspected the relevant records and toured the first three floors of the house. The resident therapists accommodation was not inspected. The inspector met four of the current six guests of the Centre and was able to speak to three of them individually. The inspector was also able to meet the director and deputy director of the Arbours Association and two of the team leaders during the course of the day. People staying at the Crisis Centre are referred to as guests so this is the term used in 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 three sessions of psychotherapy each week with a team leader and a resident therapist. In addition, Art therapy is offered on a weekly basis and the centre will shortly be offering weekly movement therapy and yoga. The feedback from the three guests that the inspector spoke to was very positive. Two guests said they were benefiting from their stay at the Crisis Centre and said that that it had helped them a lot. One person said that she was really happy that her local authority had agreed for her to stay longer at the centre. A third guest was not sure whether s/he had benefited from staying at Crisis Centre but did say that staff had been helping her. Staff were described as caring and supportive. 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. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 6 The house is well maintained, 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 support, intensive psychotherapy, good food and a homely environment is provided. What has improved since the last inspection? What they could do better: The Arbours Association needs to ensure that any staff/therapists who work at the centre have been properly checked before doing so. Although progress has been made since the last inspection, the requirement made last year has been restated as the inspector found that one staff member did not have a CRB (criminal records bureau) disclosure available for inspection. A resident therapist had started working at the home before the CRB disclosure was obtained which is not acceptable. The nurse manager told the inspector that The Arbours Association were aware of this requirement to ensure that the CRB disclosure had been received by the Association before any employee or therapist is employed at the centre and would ensure that this does not happen again. A requirement is made in this report that no further paid or voluntary staff member is allowed any unsupervised contact with any guest until a satisfactory ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 7 CRB disclosure has been obtained by Arbours. Other requirements made are to ensure an application is made to register the manager and to review the centre’s policy of not providing locks on bedroom doors for the guests. 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 G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 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 standard(s) 2, 3, 4 and 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. 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. An assessment is carried out of the person’s needs and they are fully informed about the centres regime. 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 G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 10 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 standard(s) 6, 7, 8, 9 Guests are consulted and fully involved in all aspects of life at the centre. They are encouraged to retain independence and autonomy over their own lives and are supported to take risks as part of that lifestyle. Care plans do not generally reflect all the positive work being done and some do not address the person’s global needs so it is not possible to state that each guest’s needs are fully reflected in their individual plan. EVIDENCE: Guests were able to tell the inspector that they make their own decisions about their lives and are encouraged to be as independent as they feel able to. Two guests gave examples of situations where staff have supported them to follow their individual interests and become more independent. The inspector looked at records relating to three guests. One had an assessment and care plan which had been reviewed regularly and updated. The other two had a care plan regarding their therapy programme. The plans had not been updated. The basic care plan in use describes the therapy plan for the guest but does not address their global needs so does not meet the national minimum standards. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 11 From discussion with the manager, three guests and two resident therapists, it was evident to the inspector that a great deal of positive work is taking place with individuals, but this is not necessarily reflected in the care plans. The inspector discussed care planning in detail with the nurse manager and advised how standards 2 and 6 in the National Minimum Standards for Care Homes for Adults could help ensure that each person’s global needs were addressed. The inspector also advised that guests should be asked if they have any cultural needs/preferences and that this should to be included in their plan of care. A recommendation is made at the back of this report to review all care plans, update them to ensure they reflect current practice with each guest and to address each guest’s global needs. The inspector was informed that all guests have a written risk assessment. The inspector looked at three risk assessments and these described the risks for the person and how the risks could be minimised. Guests are consulted and involved in all aspects of the day to day life in 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 were also decorating communal rooms. The inspector was informed by a resident therapist that guests are informed each week about who will be coming into the centre during that week and for what reason. 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. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 12 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 standard(s) 11, 12, 13, 14, 15, 16, 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: The inspector assessed these standards through discussion with three guests, a team leader, resident therapists and the nurse manager plus reading articles and books written by the Arbours Association. Guests have a structured psychotherapeutic programme comprising three individual therapy sessions each week with their therapy team (resident therapist and team leader), plus three group therapy sessions (house meetings). Art therapy is also offered on a weekly basis and guests are encouraged to take part. Movement therapy and yoga will shortly be offered ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 13 on a weekly basis. As well as the structured therapy sessions, guests have time to follow their own interests. Guests are free to go out as they wish and all do so. One guest has joined a local gym and said she goes on a regular basis. Another said she is planning to join a local dance class. Another guest said that sometimes a group of people would go out together, for example to the cinema or a local park. A creative house meeting is held one evening each week where any guest or resident therapist can choose an activity for everyone to take part in. These activities have included painting, going for a walk together and listening to music. Guests are able to retain their relationships with friends and family members and make their own decisions whether to have contact with them. One guest said that a partner or friend can stay overnight or for the weekend if the other guests agree. Guests are aware of their rights and responsibilities. The contract, signed by them, sets out the conditions of their stay and they are aware that they are expected to attend their scheduled therapy sessions. The inspector was told that violent and threatening behaviour towards others in the Centre is not tolerated and a guest is asked to leave (temporarily or permanently) if they behave in a violent way to another guest or therapist. The standard of meals at the Centre is excellent. Guests are fully involved in choosing the menu and are encouraged to take part in shopping and cooking. There is a rota for preparing lunch and dinner each day which therapists and guests share. The inspector saw the rota. Guests told the inspector that if somebody does not feel able to make a meal for the group they are offered help to do, so but some choose not to take part in cooking at all. The inspector had lunch at the Centre which was a selection of salads, chicken and vegetarian dishes. A guest told the inspector that this was a typical meal. Records are kept of meals eaten as required. The records were available for inspection but the inspector did not look at them on this occasion. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 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 standard(s) 18, 19 and 20 Careful attention is paid to identifying and addressing each person’s emotional health needs through an intensive therapeutic programme. There was no evidence to suggest there were any unmet needs regarding physical health. The guests are protected by the centre’s practice and procedures regarding the storage, administering and recording of medication and they are able to control their own medication if they are able and want to do so. EVIDENCE: The inspector was able to make a judgement on whether emotional health needs were being addressed based on discussion with the nurse manager and individual guests. Due to the intensive therapeutic programme, guests’ emotional health needs are continually reviewed and addressed. This information was not stored in the files of two of the three guests whose records were inspected. The nurse manager explained that the clinical team discuss each guest in detail and this information is recorded in the notes take at each meeting. Two of the three guests that the inspector was able to speak to said that they had benefited from their stay at the centre and one of them said she was getting better due to the help she had received there. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 15 At the time of this inspection, one guest had been admitted to a psychiatric hospital following an incident at the home. If a guest becomes unwell or disturbed in a way that cannot be managed at the centre, they are at times admitted to hospital. Due to the lack of information in two of the care plans, it was not evident whether people’s physical health needs were fully assessed and addressed. However, the inspector was made aware that one guest had physical health needs and had found no reason to suggest that this person’s health needs were not being met. The nurse manager also said that staff were supporting another guest to attend appointments regarding a physical health need. Five of the six current guests are taking prescribed medication. The philosophy of the centre is that individuals make their own decisions as to whether they want to take medication or not. At the time of the inspection, none of the guests were self medicating. The inspector looked at the medication cabinet and the medication records. These were both satisfactory. One error had taken place in recent months when a staff member gave a guest the wrong dose of medication. Appropriate action was taken, medical advice was sought immediately and the incident reported to the CSCI. The inspector did not have any concerns about medication at the time of this inspection. The nurse manager said that one guest is working towards self medication and that later in the week she would be meeting with him/her to plan how s/he would take over his/her own medication. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 16 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 standard(s) 22, 23 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 and found to meet the required standard. There have been no formal complaints in the last year. One person told the inspector that she felt her views were listened to and had been acted on. The inspector did not ask to see the centre’s adult protection policy nor policy regarding guests’ personal money on this occasion. The nurse manager informed the inspector on the pre-inspection questionnaire that both these policies were available. These may be requested at the next inspection. There have been no adult protection investigations regarding anyone staying at the centre. There have been fifteen admissions to local accident and emergency departments from the centre in the last twelve months. The majority of these have been due to incidents where a guest has deliberately harmed themselves. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 17 The inspector discussed self harm with the nurse manager 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. Medical attention is sought appropriately and the person’s emotional needs discussed by the team to plan how best to help them. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 18 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 standard(s) 24, 25, 26, 27, 28 The centre provides a homely, comfortable, clean and attractive environment for people to stay in. There is a range of shared spaces to meet guests’ different needs. People are able to make choices about the décor and furnishings. The policy of not allowing locks on bedroom doors means people’s right to privacy is not fully respected and this needs to be reviewed to ensure people’s rights are fully addressed. EVIDENCE: The centre is a large Victorian house which is in a good location. The street is a quiet residential street and the centre is not distinguishable from other houses. The amenities of Crouch End are two minutes walk away and there are bus services nearby. The house itself is on four floors and has a large garden which contains a wooden studio for guests to use. The garden has a pond and is maintained to a high standard. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 19 The house provides a range of communal rooms. There is a lounge which is for relaxing and a large room for house meetings and therapy sessions. Good quality furniture is provided and the house is evidently well cared for. The standard of cleanliness was also excellent. Everybody shares cleaning duties and a part time housekeeper is also employed. Each guest is able to personalise their bedroom as they wish and some have done so. The inspector looked at four bedrooms. Three had been personalised and the guests said they were very happy with their room. One bedroom has its own roof terrace. Some rooms have been decorated since the last CSCI inspection and another is in the process of being decorated. Guests’ bedrooms do not have a lock. This is intentional and fits in with the philoposophy of the centre. Guests are also informed before coming to the centre that their rooms will not have a lock. However, a requirement is made in this report to consult all guests to review this decision and inform CSCI of the outcome by 30 August 2005. It is specified in the National Minimum Standards of care homes that people’s bedrooms are lockable. This is to provide privacy. The type of lock suitable for care homes is of a hotel type. The guest should be able to lock their door from the inside by turning the catch. From the outside, the lock can only be opened with a key, of which the guest has one and the therapists/staff have one. This would enable the staff to enter the room if there are concerns for the person’s safety or in any other emergency. It is strongly advised that suitable locks are fitted to bedroom doors so that all guests who wish to use the lock can do so to safeguard their privacy. Chubb or Yale locks may not be used as these are considered to be a fire, health and safety risk. The inspector noted that two wooden toilet seats had writing scratched into them. The nurse manager said she would arrange for them to be replaced immediately. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 34, 35, 36 Guests living at the centre benefit from a caring and well trained staff team who are well supported and supervised. Guests are not always protected by the centre’s recruitment practice in that the inspector was aware of two staff who had been allowed to start work at the centre before a Criminal Records Bureau check had been received by Arbours. EVIDENCE: The three full time resident therapists receive training and regular individual and group supervision. They are all undergoing psychotherapy training with Arbours Association. The staff tam comprises resident therapists, team leaders and nurse manager. The director and deputy director of the Arbours Association are closely involved in the centre. There is a team leader on-call 24 hours a day to offer support to the resident therapists if necessary. The centre is registered as a nursing home and as such is required to have a qualified nurse on duty 24 hours a day. The nurse manager and one of the resident therapists fulfil this requirement. When neither is on duty there is a locum therapist/nurse and infrequently nurses from an agency are used. The staff team work closely together and have frequent meetings to discuss the work being carried out at the centre and guests’ individual needs. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 21 The inspector asked to see the CRB disclosures and other records for all staff who have contact with guests at the centre. A sample of three staff records were chosen at random for full inspection. All three had two references as required and full information on the person’s employment history. Two had an up to date CRB disclosure but one did not. This person had applied for a disclosure to be carried out but had been allowed to work as a resident therapist before the disclosure has been received by Arbours. The majority of staff had an up to date enhanced CRB disclosure which is positive. One disclosure was not present in the centre to be inspected. The nurse manager agreed to ensure a copy is obtained from this person. Two have applied and their disclosures have not yet been received and the registered persons had not been aware of the requirement for domestic staff to have a disclosure. The requirement for everyone working at the centre on a full or part time basis to have a CRB disclosure was explained to the nurse manager who agreed to ensure this was complied with. She assured the inspector that the registered persons were aware of the requirement for therapists to have a CRB disclosure before starting at the centre and that no further staff would be employed until a satisfactory disclosure had been received. Requirements are made at the back of this report to ensure that the CRBs not available for inspection today are made available to the inspector before 30 August and to ensure that no staff are allowed to work with any guest before a satisfactory CRB disclosure is received at the centre. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 22 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39, 42 Guests benefit from a well run service, within which they are respected and involved. It was not appropriate to form a judgement regarding the quality assurance system as a new system will be implemented in the near future. While the health and safety of guests is protected, fire safety was not fully inspected on this occasion. EVIDENCE: The Associate Director explained to the inspector that Arbours had been unable to implement its proposed formal quality assurance system due to a legal battle. This is expected to be resolved shortly. In the meantime, she was able to inform the inspector of the current quality assurance processes. The new system which will meet the national minimum standard 39 will be inspected at the next CSCI inspection of the centre if not forwarded to the CSCI beforehand. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 23 The current nurse manager is not registered as manager and advice was given to her regarding the requirement for NVQ level 4 training and applying for registration. With regard to health and safety, the inspector looked at a small sample of health and safety issues during the day. An inspection of the electrical installation and appliances had taken place in August 2004. A bulb for the emergency lighting system needed to be replaced. The centre has a clinical waste disposal contract. The house was clean and hygienic and no obvious health and safety hazards were noted. Advice was given to provide fire retardant fabrics and fire proof bins for cigarette disposal in bedrooms of guests who smoke. The nurse manager informed the inspector that toughened glass was fitted to bedroom windows for safety reasons and the inspector saw that a window restrictor was present in the four bedrooms seen. The nurse manager said that these are present in all guest bedrooms. The resident therapists’ bedrooms on the fourth floor do not have window restrictors. This was discussed with the nurse manager who said that this was not currently a risk to any guest. She agreed that a risk assessment would be undertaken regarding each current and future guest so that if an unrestricted top floor window was regarded as a risk, then either a window restrictor would be fitted or the room would be kept locked. Fire safety was not inspected on this occasion. At the next inspection, records of weekly tests of the fire alarm call points, quarterly fire drills, fire training records and records of inspections of the fire alarm system and fire fighting equipment and the centre’s fire risk assessment will be checked. The inspector advised the nurse manager to contact the LFEPA, or request that the Arbours own fire officer do so, to obtain LFEPA advice on specific fire safety matters that were discussed during the inspection. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 24 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 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 3 3 x x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 ARBOURS CRISIS CENTRE Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 2 2 x x x x G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 25 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 26 Regulation 12(3)(4) (a) Requirement The registered persons must consult each guest and review the policy of not providing suitable locks on bedroom doors and inform the CSCI in writing of the outcome. The registered persons must make the CRB disclosures for five named staff available for inspection in the crisis centre. The registered persons must ensure that no further paid or voluntary staff member is allowed to work or have any unsupervised contact with any guest until the registered persons have received a satisfactory enhanced CRB disclosure for that person and a copy is kept in the crisis centre. The registered persons must ensure that an application is made to register a manager for the crisis centre. The registered persons must make a copy of the new quality assurance policy and annual development plan available for inspection. Timescale for action 30 August 2005 2. 34 19(1)(b) (i) 19(1)(b) (i) 30 August 2005 24 May 2005 and from then on 3. 34 4. 37 9 30 August 2005 30 August 2005 5. 39 24(1)(2) ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 26 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 6 Good Practice Recommendations The registered persons should review the current care plan format to ensure that guests global needs are being addressed and update the plans so that they reflect current practice with each guest. 2. ARBOURS CRISIS CENTRE G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection 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 © 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 G59 S27800 Arbours Crisis Centre V213404 23.05.05 Stage 4.doc Version 1.30 Page 28 - 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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