Inspection on 05/12/08 for Arbours Crisis Centre

This inspection was carried out on 5th December 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Arbours Crisis Centre 05/07/07

Arbours Crisis Centre 18/01/07

Arbours Crisis Centre 20/10/05

Arbours Crisis Centre 23/05/05

Arbours Crisis Centre 26/10/04

Arbours Crisis Centre 27/04/04

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Townley Road, 2-3

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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 27/02/2009.

CARE HOME ADULTS 18-65 Arbours Crisis Centre Arbours Crisis Centre 41a Weston Park Hornsey London N8 9SY Lead Inspector Jackie Izzard Unannounced Inspection 5 , 9 and 15 December 2008 10:00 th th th Arbours Crisis Centre DS0000027800.V373570.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.V373570.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 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.V373570.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 No registered manager Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th January 2008 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 from £1600 to £2450 per week. 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 four women living at the Crisis Centre. Arbours Crisis Centre DS0000027800.V373570.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place on 5, 9 and 15 December 2008. The inspection on 15 December was by a CSCI pharmacist inspector due to concerns found on 9 December about management of medication in the service. The inspection consisted of the following; meeting with the new Centre director whom Arbours intend to put forward as the new responsible individual for the company, meeting the Centre manager and speaking in private to three of the four people living at the Crisis Centre. We also looked at care plans, risk assessments and other records relating to the guests to see if their needs had been assessed and were being met. We looked at resident therapist files to see if they had been properly vetted, trained and supervised. We looked at management of medication and record keeping. We also looked around the house and checked some health and safety records. There were four women living at the Crisis Centre at the time of this inspection. Arbours refer to people who are living at the Crisis Centre as guests and this is the term used throughout this report. The last inspection of the Crisis Centre took place in January 2008 and was a random unannounced 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 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 there are three resident therapists who live in and a small team of therapists who stay at the centre at weekends when the resident therapists have weekends off. Arbours Crisis Centre DS0000027800.V373570.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. 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 in a quiet residential area is provided. Guests say the service helps them and that they are happy with it. What has improved since the last inspection? What they could do better: Thirteen requirements are made in this report. These are actions that Arbours Housing Association need to take in order to improve the service offered to guests and to protect their health and safety. There is a need to improve unsafe medication practices and poor recording of medication. The lack of attention to safe medication practice puts guests at risk of not receiving their prescribed medication and of medication errors. Three requirements are made to improve medication practices. Other requirements made are to improve care plans and risk assessments, improve fire precautions and to review and update the centre’s policies and procedures. Staff need to be trained in safeguarding vulnerable adults procedures. A requirement is made for Arbours to inform the Commission of the measures being taken to ensure the Crisis Centre is suitably managed as the current manager is not registered. Three recommendations are made. These are good practice recommendations. Two relate to improving medication and the other is to devise a policy on working with self harm to guide staff on how to best support guests who harm themselves. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 7 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.V373570.R01.S.doc Version 5.2 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.V373570.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 Quality in this outcome area is good. 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. Their needs are assessed before they are offered a place at the centre. EVIDENCE: Admissions to the Crisis Centre are usually well planned. 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. Arbours has produced a detailed admission and consultation procedure that requires full information to be received and an assessment to be undertaken before any guest moves into the Crisis Centre. We looked at the assessment documents for three of the four guests and found that the quality of the assessment information was adequate. The company’s assessment procedure and documents had not been followed properly for one resident by the person carrying out the assessment but the assessment for the other two was more consistent with the agreed process. There was written information about each guest’s needs completed before they moved into the Centre showing that there had been consultation with other people involved with them in order to get a Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 10 picture of their needs. The requirement to assess people’s needs before they move into the centre was therefore met. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is adequate. 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. They will benefit from more detailed risk assessments and an improved care plan format which addresses their holistic needs. EVIDENCE: We assessed the care plans and risk assessments for three of the four guests. The format used for care plans is based on the service offered at the Centre rather than a person centred plan which addresses an individual’s identified needs. The format therefore does not address needs and wishes that do not fall into the mental/emotional health area. This aspect of guests’ needs is addressed in a comprehensive and detailed way. Physical health, cultural, religious and social and other needs are not included in the plans. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 12 On the second day of the inspection we were shown a new care plan format which is intended to be introduced in 2009. This format was much improved as it addresses a person’s holistic needs. In practice the manager was able to describe how a guest’s religious and cultural needs have been well met but this information is not recorded. A requirement is made to ensure the new format is implemented for the benefit of the guests. Risk assessments have improved following enforcement action taken by CSCI last year, when a statutory requirement notice was served on the Arbours Association requiring them to improve risk assessments. The risk assessments are reviewed regularly. Risk management plans particularly relating to risks of self harm and suicide were not always specific about what action resident therapists/staff were expected to take in relation to identified risks. A requirement is made to ensure that risk management plans are more detailed to guide staff in how to support guests in areas of high risk. In practice two guests told us that they felt they received the right kind of support when they harmed themselves and when they felt suicidal. They also said that they were encouraged to be as independent as possible within the expectations that they attend the planned therapy sessions and house meetings. Guests said they were consulted on all aspects of life in the centre at the regular house meetings and were able make decisions and choices, particularly about decor and equipment for the house which they appreciated. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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: Within the Crisis Centre, guests attend a minimum of three therapy meetings each week with their team, which comprise a psychotherapist and a resident therapist. The three resident therapists live in the Crisis Centre and are training to be psychotherapists. Guests can have more therapy sessions each week if needed including family therapy sessions. There are in addition four group meetings (“house” meetings) along with art therapy, movement therapy and yoga. One of the group meetings is a creative activity where guests choose what to do. We asked one of the guests about the activities; Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 14 movement therapy, art therapy, creative group and yoga and she said that guests enjoyed these. Two guests said that resident therapists and guests would have some social activities over the Christmas holiday period such as going to see a show and go out for a meal. One said that the group were discussing a regular group meal out for guests and that resident therapists would go out with a guest for walk or for a coffee in a café. The guests said that they were expected to participate in all the structured sessions but could choose not to. All guests said they would like more structure; ie more organised activities, but are aware that time to think and spend unstructured time in the house is seen as part of the therapeutic programme. People make 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 to live in a smoke free environment. Guests are fully involved in decisions regarding running the centre and have a housekeeping meeting weekly. Cooking is shared and support to cook for the group is available from the Resident Therapists. Guests generally eat as a group with the resident therapists but do not have to and they choose what they want to eat. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. 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. However a lack of attention to safe medication practices means they may be at risk from the centre’s poor medication management. EVIDENCE: Guests’ health needs were recorded and we discussed physical health needs with two of the guests. Both guests said that staff supported them with their physical health needs and injuries relating to self harm. Resident therapists accompany guests to hospital where needed and to GP appointments. Due to the nature of the guests’ needs there is a current high level of self harm and therefore frequent hospital visits. Guests said they received the support they needed with this and we saw records made of hospital appointments with the outcome recorded. 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. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 16 Despite the introduction of a new monitored dosage medication system, during the inspection we found a number of concerns about medication indicating unsafe medication practices. The concerns found were that • One guest had been mistakenly given the wrong medication and there was no written procedure to contact NHS services for guidance in such circumstances. In only two days of the new medication administration record charts, there were examples of medication being given and not recorded and prescribed medication not being given with no explanation recorded. There were five different painkillers available to guests as homely remedies. No times were recorded for painkillers being given to guests to ensure that doses were a safe time apart. The number of paracetomol in the container did not match the number that the medication sheet indicated should be there and the manager could not account for the discrepancy. • • • • As a result of these concerns a CSCI pharmacist inspector carried out an inspection of medication on 15 December. This inspection report is as follows; The home was in the first 4-week cycle of prescribing and supply following change of dispensing pharmacy to Boots commencing 06/12/2008. This change now includes medicines supply using the Boots monitored dosage system (MDS) together with medication administration record (MAR) charts with printed details of dispensed pharmaceuticals supplied by Boots. It was not possible to audit medication in the home to confirm administration was in accordance with the prescriber’s directions as the record of receipt or carry-forward of medication from the previous chart was either inaccurate or absent. Also, the need for accountability requires any additions or changes to the charts to be endorsed with the date and signed initials of the authorised person making the entry. At present a separate record book is kept for recording the disposal of pharmaceuticals. In the interest of providing the complete audit trail on a single document it was decided that in view of the small number of users of the service that record of the disposal of pharmaceuticals recorded on the MAR charts would be included in the section allocated on the chart for this purpose. Items not included on the MAR chart, for example homely Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 17 remedies for general use, may continue to be recorded in the book for disposal. Medication prescribed without adequate directions, for example to be taken as required or as directed, requires additional guidance to be documented with the MAR chart to provide full administration requirements including information such as the indication for treatment, dosage, minimum interval between doses, maximum dosage within a time period, etc. A cover sheet to precede the MAR chart(s) for each user of the service can be provided for reference information including a photograph to confirm identification, allergy status, any special dietary requirements and any information that may aid the effective use of medication. The cover sheets will also organise the MAR charts by acting as a divider between the MAR charts for each user. Medication policies and procedures (P&P), including that for selfadministration of medication, was documented and available for reference. The P&P had been compiled without the benefit of documented medication guidance from the CSCI and Pharmaceutical Society (RPSGB) and required more detail to provide comprehensive control of medication, including how to deal with medication errors. We discussed the guidance available from the CSCI and RPSGB websites and how they may be accessed. The home’s list of homely remedies for treating minor ailments included too many items with duplication of medicines treating the same ailments and some that can interact with prescribed medication. Rationalising the list to suitable treatments was discussed as being a priority with the proviso that any non-listed remedies requested by users for individual use be referred to the prescriber, included on the MAR chart and recorded in the care plan. Provision for medication training included the foundation course of instruction by Boots on 06/10/2008, however, reference to training is required in the P&P including the need to check the competency of staff dealing with medication and frequency of review. Medication for use by users of the service during short periods of leave from the home requires inclusion of the details of the medication taken. Longer periods of leave can be provided for by a prescription for the period, dispensed by the pharmacy in separate containers. There were no Controlled Drugs (CD) currently prescribed for users of the service and a CD cupboard was provided within the medicines cupboard. This cupboard was unable to be accessed as it was locked and the key not available. In view of the CD cupboard occupying a quarter of the cupboard, we discussed the option of providing a separate CD cupboard, thereby freeing the space currently occupied by the CD cupboard to increase the storage for other medicines. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 18 There were no medicines requiring cold storage, however, we discussed the security requirements, bearing in mind the low demand for such storage. This includes storage within a labelled and locked box kept within a small spare fridge currently available in the home. Temperature monitoring to be documented using a maximum/minimum thermometer to evidence temperatures are within the licensed storage requirements. Reference to medicines information was currently provided with a copy of Mims. This function would benefit by including a recent edition of the BNF that is to be made available for reference at the point of medicines use. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Guests feel their views are listened to and acted on 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. The Centre needs to make improvements in 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 acted upon. We discussed self harm with two of the three guests who both said that they considered they received the right kind of support with their self harming. The centre’s safeguarding policy was not up to date and did not reflect current practice and a requirement is made to update this policy and ensure all staff are trained in safeguarding as a priority. The new centre director showed knowledge of safeguarding processes. We advised the manager to contact the local safeguarding coordinator for information. There have been no safeguarding issues since the last inspection. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 20 A recommendation is made to devise a policy and procedures for working with self harming behaviour as this is an important part of the work carried out at the centre but the organisation has no written policy nor guidelines to advise staff on how to support guests in this area. This may promote consistency and benefit guests. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Guests live in a homely comfortable environment where they are involved in planning improvements. EVIDENCE: We looked at communal rooms and discussed the environment with three guests and the centre manager and director. The house is homely and comfortable. Guests said the shower and oven were not working properly. They also said that funding has been arranged to replace these items and that all guests had been involved in choosing replacements. Guests told us that they have been fully consulted on what improvements should be made to the house and had made a list of suggested improvements. The standard of cleanliness in the kitchen, bathrooms and toilets was adequate but a more thorough cleaning would improve the physical environment. We were informed that a new Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 22 cleaner has been employed and that the standard of cleaning was expected to improve. 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. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is adequate. 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: The centre manager informed us that the staff team has assessed that there was no need to have anyone awake at night to support the guests and that a risk assessment had concluded that the current arrangements of guests waking up resident therapists if they need help in the night was sufficient for their needs. This risk assessment had not been recorded so it was not possible to inspect it. A requirement is made to undertake a risk assessment on this issue and record the findings as evidence that guests have been consulted and that the risk of suicide/self harm at night has been addressed and minimised. There was evidence from discussion with a resident therapist and from inspection of records that there is a higher incidence of self harming behaviour requiring hospital treatment at night. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 24 We therefore discussed night time staffing arrangements with three guests. They gave their individual views and all felt that it was not necessary to have someone awake all night “on duty.” Currently they go upstairs to wake one of the resident therapists if they need to go to hospital or if they need any other support. They said this issue has been discussed with them and 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. This is an unusual arrangement but current guests said it did meet their needs. Records showed that there have been periods where staff are up at night very frequently. They said cover staff are brought in if they have had to be awake all night with a guest. One guest said that at times two staff will sit up at night with them and that support was flexible. One of the three guests we spoke with on this issue said that she had no support needs at night. Two did and had requested support during the night on a regular basis. During the day and evening there are always two resident therapists in the house and available to guests. A requirement was made in 2007 to initiate induction training for resident therapists. During this inspection the records of the induction of current staff could not be located, however these were sent to us a few days later and we noted that an induction had been provided. The manager is responsible for arranging the staff training programme . We did not ask to see this year’s training plan at the inspection. We did see certificates and confirm that they had been trained in food hygiene and medication but we did not check other training. We looked at recruitment records for two of the three resident therapists currently living at the Crisis centre. The third had been at the centre for a longer period of time and his records had been previously inspected. The reason for inspecting recruitment records is to ensure that Arbours vet the people they employ to ensure they are suitable to work with vulnerable adults. One had the required two written references and criminal records bureau (CRB) disclosure before being allowed to start work which indicates a safe recruitment practice. However, the other had been employed and moved in the crisis centre before a criminal records bureau disclosure or check against the list of people unsuitable to work with vulnerable adults (POVA first check) had been carried out . This means that s/he had not been vetted for suitability before being employed and this could have put guests at risk. The checks for this person were seen to be in place at the inspection and there is no current risk. A requirement is made to ensure that this does not happen again and that all staff/therapists are fully checked before being allowed to have contact with guests. Resident therapists receive regular supervision about their work and attend regular meetings to discuss their work with guests, and team leaders advise Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 25 them on a frequent basis both through their meetings and by an on call rota system. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 Quality in this outcome area is adequate. 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. Greater attention to fire precautions would improve the protection of guests and staff health and safety. EVIDENCE: There has been no registered manager for the Crisis Centre for the last few years. Managers have been employed but have not completed the registration process. The current manager is not registered so a requirement is made that Arbours inform the Commission of what management arrangements they will keep in place to ensure the Crisis Centre is well managed. The current manager said that she is well supported by the new director and he confirmed that he is providing weekly supervision for the manager. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 27 Both he and the manager said they were committed to making improvements to the service at the Crisis Centre. Regulation 26 monthly reports on the Centre will be implemented by the new director in 2009. Guests said they were satisfied with the running of the Crisis Centre and thought that a good service was provided which was helping them. They felt they were consulted and supported well and their views regularly sought and listened to. There are weekly clinical meetings to discuss guests and all staff from 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 to the resident therapists if they need advice. We looked at a sample of health and safety records and fire safety issues. Despite a monthly inspection by the provider’s own fire officer there were improvements needed to fire safety. During a tour of communal rooms it was evident that a number of fire doors in the house including the kitchen door did not fit properly and therefore could not contain a fire. From examination of the last three fire officer reports there was no record that fire doors had been checked. The manager also told us that staff at the centre do not check fire doors as part of their health and safety checks. It is of concern that doors which clearly do not close properly have not been replaced or repaired and a requirement is made to do so to protect guests from risk of a fire spreading. The new centre director gave us assurance that this would be quickly resolved. The fire risk assessment dated February 2007 stated that rope ladders are available as alternative fire escape from the top floor where resident therapists live. There was no record that these were checked for safety and suitability. A requirement is made to ensure that fire escape arrangements are safe and suitable in the event of a fire. A requirement was made previously to cease storing irons and ironing boards on the landing where they could impede exit in the event of a fire. This requirement was not complied with. It is the responsibility of the provider to ensure fire exits are kept clear at all times and a requirement is made to do so. The fire alarm has been tested and was working at the time of the inspection. Staff at the centre check the fire alarm weekly and record this and the contractor has issued an inspection certificate. An environmental health inspection took place in August 2008 and cleaning of kitchen equipment was recommended in that report. We did not check whether this had been complied with but were informed that the fridge and microwave were cleaned by the new cleaner. There were no guidelines for the storing of hazardous substances (COSHH) and we advised that a 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.V373570.R01.S.doc Version 5.2 Page 28 The latest electrical test showed the result of the inspection to be unsatisfactory and we were informed that remedial electrical work was in progress. A requirement is made to advise CSCI when the electrical inspection is deemed to be satisfactory. Incidents required to be reported to the Commission are being regularly reported. A sample of policies were looked at during this inspection and it was found that these had not been reviewed for a few years and were not up to date. The procedures for medication and safeguarding were particularly noted as not meeting minimum standards. A requirement is made to review policies and update them where they do not reflect current legislation or good practice. Arbours Crisis Centre DS0000027800.V373570.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. 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 Score 1 3 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 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 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 3 X 3 X 2 2 X Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 30 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 YA6 Regulation 15 Requirement Timescale for action 28/02/09 2 YA9 13(4)(c) The new care plan format must be introduced so as to ensure guests’ holistic needs are known and addressed. Guests should be involved and should be given a copy of their care plan. Risk assessments and risk 01/02/09 management plans must be specific about the type of support to be provided for guests in high risk situations such as self harm and risk of suicide. This is to ensure that guests are given the support they need to minimise serious harm. A risk assessment regarding the risks to guests of self harm at night time must be undertaken including consulting with each guest and recording the assessment and any resulting action in writing. This is to ensure that night time staffing arrangements are satisfactory to meet guests’ night time needs. 3 YA9 YA33 13(4)(c) 01/02/09 Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 31 4 YA20 13(2) 5 YA20 13(2) 6 YA20 13(2) 7 YA23 13(6) 8 YA23 13(6) 9 YA37 9 10 YA40 YA41 24 Medication records are required to be complete and accurate to facilitate auditable control of medication. Documented medication policies & procedures are required to be updated and provide full controls on medication Secure storage and monitoring arrangements are required for medication requiring cold storage. The registered persons must ensure that the centre’s policy and procedures for safeguarding vulnerable adults are up to date and include current national policy. All staff must have attended certificated training in safeguarding of vulnerable adults. The registered provider must inform the Commission in writing of the arrangements made to ensure the centre is well managed. The registered persons must review all policies and procedures, update as necessary and ensure these comply with current legislation. 12/01/09 12/03/09 12/01/09 30/01/09 28/02/09 30/01/09 28/02/09 11 YA42 13(4)(a) This is to ensure that practice in the centre reflects up to date practices Confirmation that the electrical 30/01/09 installation to the crisis centre has been inspected as satisfactory must be available for inspection. This is to ensure the electrical wiring is safe. Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 32 12 YA42 23(4) All fire doors must close properly at all times and must be checked on regular basis to ensure they continue to do so. Fire escapes must be regularly checked and kept clear. This is to improve fire precautions. A risk assessment and written plan for the control of substances hazardous to health (COSHH) must be in place. This is to promote health and safety of guests and staff. 12/01/09 13 YA42 13(4) 30/01/09 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. 2. Refer to Standard YA20 YA20 Good Practice Recommendations To review the storage facilities for Controlled Drugs to improve arrangements for medicines storage. To make available current references on medication including a recent edition of the BNF and the CSCI and Royal Pharmaceutical Society’s guidance documents on medication in care homes. The registered persons should ensure a policy and procedures for working with people who self harm is made available for staff to advise them how to consistently support guests with self harming behaviour. 3. YA23 Arbours Crisis Centre DS0000027800.V373570.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000027800.V373570.R01.S.doc Version 5.2 Page 34 - 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. 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