Inspection on 05/07/07 for Arbours Crisis Centre

This inspection was carried out on 5th July 2007.

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. 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 05/12/08

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

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 Arbours Crisis Centre 41a Weston Park Hornsey London N8 9SY Lead Inspector Jackie Izzard Key Unannounced Inspection 5th July 2007 11:00 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.V338346.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.V338346.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 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.V338346.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30 April 2007 Brief Description of the Service: The Arbours Crisis Centre is registered as a care home for people with mental health problems. 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 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 £1960.00 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 two women living at the Crisis Centre. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 5 July 2007 and was unannounced. The inspection was undertaken by two inspectors; Jackie Izzard and Susan Shamash. The purpose of the inspection was to check on compliance with an enforcement notice served on the Arbours Housing Association Ltd (hereafter referred to as ‘Arbours’) on 18 May 2007 as well as undertaking a routine key inspection. The inspection took place from 11am to 6:15pm and consisted of the following: • • • • • • • • • Meeting the responsible individual for the Arbours Housing Association Ltd Checking on compliance with the statutory requirement notice served on Arbours on 18 May 2007 Following up requirements made at the last CSCI inspection on 30 April 2007 meeting privately with the two people currently living at the Crisis Centre Meeting with one of the resident therapists Inspection of staff and guest files Examination of various records, policies and procedures Tour of the house and garden Inspection of health and safety records. There were two 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 on 30 April 2007. The reason for this inspection was to check on the safety and welfare of guests and to find out further information regarding the death of a guest a few days before the inspection. The findings of this inspection were that an inadequate risk assessment was undertaken on this guest and no full assessment of the person had been obtained before the person moved into the Crisis Centre. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 6 A total of twelve requirements were made at the previous inspection. These were actions that Arbours Housing Association Ltd had to take in order to improve the health and safety outcomes for the guests and to comply with the Care Homes Regulations 2001 and the National Minimum Standards for care homes for adults. Short timescales were given to comply with these requirements. Although Arbours responded to the requirements, the CSCI considered that some of the requirements had not been fully complied with and on 18 May 2007 a statutory requirement notice was served on the organisation. This required Arbours to comply with a list of requirements by 25 June to avoid further action by CSCI. These requirements related to • • • • • Having thorough risk assessment and risk management plan in place before guests move in To produce comprehensive written risk assessment, risk management and care planning systems To undertake a risk assessment to be satisfied as to the safety of current guests, including assessment of the environment, staffing and procedures. Obtaining written assessment of potential guests and consulting with their placing authority before admission Improving the system of notifying CSCI of notifiable incidents and ensuring they notify CSCI of any event under Regulation 37 of the Care Homes Regulations 2001. 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. 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. An attractive 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.V338346.R01.S.doc Version 5.2 Page 7 support, intensive psychotherapy, good food and a comfortable homely environment in a quiet residential area is provided. What has improved since the last inspection? What they could do better: The following three requirements need to be complied with before CSCI consider that Arbours has complied fully with the statutory requirement notice: • The registered persons must ensure all events listed in Regulation 37 of The Care Homes Regulations 2001 are reported to the CSCI at all times. Arbours have made good improvements in the frequency and quality of reporting events but there was one exception found during the inspection. • The registered persons must include windows in the environment risk assessment for the home and record whether or not a restrictor needs to be in place for each individual window. Where it is assessed that a restrictor is needed, these must be in place. The registered persons must ensure risk assessments and risk management plans include specific strategies for addressing each risk identified for each guest. • Arbours were asked to supply this information by 19 July 2007 as evidence that the statutory requirement notice has been fully complied with. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 8 As well as the above, one requirement has not yet been fully met, and has been restated in this report with a new timescale for compliance. Further information regarding unmet requirements can be found in the relevant standard. Unmet requirements can impact upon the health and safety of service users. Failure to comply with the timescales will lead to the Commission for Social Care Inspection considering further enforcement action to secure compliance. This requirement was regarding ensuring that if a guest is not given their prescribed medication, then a clear reason for this is recorded on their medication chart. In addition, eleven new requirements were made at this inspection. These are mostly relating to health and safety issues and must be complied with. These requirements relate to making improvements in the area of medication, safety inspections of equipment in the home, to cease providing nursing care, to implement formal induction training for staff, review and update old policies and procedures, seek advice from the Fire Authority regarding locking the front door and to improve the procedure on action to be taken in the event of a serious incident. All these requirements relate to the health and safety of guest and therefore short timescales have been given. There is a total of fifteen requirements and three recommendations in the report. Recommendations are seen as good practice advice. 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.V338346.R01.S.doc Version 5.2 Page 9 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.V338346.R01.S.doc Version 5.2 Page 10 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, People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective guests have access to written information about the Crisis Centre and usually have their needs assessed before a decision is made that they move in. There has been one serious failure to carry out a proper assessment but as a result of this failure, a new assessment procedure has been devised which should ensure that all new guests have their needs assessed before moving into the Crisis 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. Current guests had been assessed before moving to the Centre and the decision as to whether their needs could be met at the Crisis Centre made by a group of people. However, in April 2007, the Crisis Centre admitted a guest as an emergency admission without having undertaken a proper assessment , Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 11 written a risk management plan nor having received any written information from other professionals. This failure to undertake a full assessment for somebody, left them and other guests at potential risk. As a result of this, a CSCI served a statutory requirement notice on the provider requiring them to immediately improve their practice regarding risk assessment and needs assessment prior to admitting any new people. Arbours has now 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. This is a positive improvement. The two current guests have had their needs assessed and the assessment documents were present on their files. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 12 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Guests’ needs are recorded in their care plan. They are supported to take appropriate risks and consulted about their care at all times. EVIDENCE: The care plans and risk assessments for both guests were inspected. The care plans were of an adequate standard and had been reviewed regularly. Risk assessments have improved since the last inspection and following the statutory requirement notice served on Arbours in May. In order to ensure that risk assessments and risk management plans address every risk to and from the each guest, a requirement is made to ensure each specific risk and the resulting management plan is recorded. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 13 In practice, inspectors saw that action had been taken recently to minimise risks to guests resulting from self harming behaviour. Records need to reflect the action taken to minimise risk. As this is a Crisis Centre, guests are often emotionally distressed and high risk behaviours, such as self harm, are commonplace. Staff work with guests to identify specific risks and minimise them while at the same time expecting them to take responsibility for their behaviours. This is a difficult balance to achieve. Inspectors considered that guests were currently receiving the right type and amount of support in the area of risk. This conclusion was made after inspecting records and talking to guests and a resident therapist. Guests are encouraged to be as independent as they are able but support and monitoring are given to help protect the person from risk. For example, people are able to go out alone but staff will keep in contact by telephone to ensure the person is safe and well. Guests are encouraged to make their own decisions with support as needed. Regular individual and group meetings take place weekly where guests are encouraged to voice their views and needs. The inspectors met with the two current guests individually to discuss their views and experiences of living at the Crisis Centre. From these discussions, it was clear that guests are encouraged to be independent and be responsible for themselves with a level of support which varied depending on their needs. One guest said that she was able to ask for the support she needed and it would be provided. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 14 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, 14, 15, 16, 17 People who use the service experience good outcomes in this area. 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 and at the time of this inspection, both guests were having therapy four times a week. There are in addition four group meetings (“house” Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 15 meetings) along with art therapy, movement therapy and yoga. One of the group meetings is a creative activity where guests choose what to do. The guests said that they were expected to participate in all the sessions but could choose not to. One guest said she would like more structure; ie more organised activities, but time to think and spend unstructured time in the house is seen as part of the therapeutic programme. Guests can go out with resident therapists as a group, eg recently there was a trip to Camden market as well as following their own interests. One person said she goes swimming and to a local gym. 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. Two of the three resident therapists have food hygiene and safety certificates. Records are kept of the meals cooked which show that good quality food continues to be served. Guests generally eat as a group with the resident therapists but do not have to if they find this too difficult. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 16 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Guests receive good personal support and support to meet their mental and physical health needs. Further improvements are needed in the centre’s procedures and practice for dealing with medication to protect the guests. EVIDENCE: Both guests’ files were examined for evidence of their health needs being assessed and met. These showed evidence that the guest’s health needs were known to staff and that they had been given the appropriate support to attend medical appointments. A requirement made at a previous inspection to ensure that health needs are recorded and met and records kept of health appointments and their outcome has been met. Records were available of appointments attended. Guests were seeing dentists, psychiatrists, opticians, practice nurses and their GPs as needed. Due to the nature of the guests’ needs, there are more frequent contacts with accident and emergency Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 17 departments of local hospitals. The inspector saw that these were recorded appropriately. Any incident of self harm resulting in a visit to a hospital is now being reported to the CSCI as required. Due to increased risk of overdose or misuse of medication in the Crisis Centre compared with other registered care homes, it is essential to be vigilant in the area of medication. The inspectors discussed medication with one resident therapist and one guest, examined medication records and looked at the home’s stock of medication and the centre’s procedures regarding medication. The Crisis Centre uses a local pharmacy who provide the guests’ prescribed medication in controlled dose boxes (dossett boxes). At the time of the inspection, two guests were taking prescribed medication. Staff have attended medication training in June 2007 and are awaiting the certificates from this training. Inspectors were told that only staff who attended this training are allowed to give out medication now which is positive and reduces risk of error. Some concerns were found regarding medication. These were: • There was a gap in a guest’s medication records where no explanation had been recorded as to why the guest did not receive her medication as prescribed . A code is now recorded on the administration sheet to explain why a medicine was not taken but the code was not always used correctl.y reason for not taking the medication was not recorded on the sheet but on a separate sheet of paper. It was explained that this was not acceptable. There was no record of all the medication in the home nor of any medication returned to the pharmacist for disposal. The medication cabinet was poorly monitored and had not been cleaned out for some time. There was excess medication being stored (six boxes of one medication), medication belonging to people who no longer live at the Crisis centre, old homely remedies several years past their expiry date (and therefore a risk to guests). A homely remedy given to a guest had not been signed for by the staff member who gave it. • • • • • Requirements are made on all these issues. Daily monitoring of the medication charts is part of the current procedure but not taking place daily. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 18 Through discussion with a resident therapist, it became clear that the Crisis Centre was providing nursing care in that a nurse employed by Arbours was visiting the centre and dressing a guest’s wounds. The Crisis Centre was previously registered as a nursing home but is now registered as a care home at Arbours’ request. Therefore nursing care must not be provided at any time. Inspectors explained that if it was not possible for a guest to see the nurse at the GP practice then district nurses must be contacted to provide any nursing care. Alternatively, the practice nurse should be consulted to see if the procedure requires a trained nurse or whether therapists who have attended first aid training could be trained by the nurse to dress the wounds. Arbours Crisis Centre DS0000027800.V338346.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): 22, 23 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Guests’ views are listened to and there is clear written guidance on how they can make a complaint. They benefit from a team of staff who are experienced in working with people who self harm. 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. The last complaint was in June 2006 and did not relate to the service provided to people at the Crisis Centre. However, the outcome of the complaint was not recorded as required. Both guests said they had no complaints. One said “it’s fine” and the other said she was doing very well at the Crisis Centre. The Centre’s adult protection procedure was not inspected on this occasion but a requirement is made later in this report to update all policies and procedures. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 20 All therapists working at the centre have experience in working with adults who have experienced abuse. Self harm is an issue at the Crisis Centre in that it is common for guests to self harm on a regular basis. The inspectors saw that this is addressed in their risk assessments and risk management plans. Also there was evidence that staff respond quickly to a new type of self harm and take action to minimise the risk of this recurring. There is no written policy nor procedure on self harm and this is something that Arbours may wish to consider as an agreed written consistent approach to self harming behaviour may be of benefit to guests and staff in knowing how best to work with these issues. Arbours Crisis Centre DS0000027800.V338346.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, 25, 26, 27, 28, 30 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The Crisis Centre 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: The house is well situated, in a quiet residential street where it blends in with domestic houses, but also a short walk to the centre of Crouch End and all its amenities. There is easy access to buses. The house comprises; a kitchen where meals are eaten, conservatory, large lounge for communal use, large lounge for therapy sessions and meetings, two guest bathrooms, three toilets and single bedrooms. There are six guests’ bedrooms and three for resident therapists, who live in. There is also an office. There is a garden and outside studio, which is used for art therapy and Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 22 other small group or individual meetings/activities. There is therefore a range of spaces where guests can be part of the group or spend time alone. The lounge has television, DVD and video player, computer and books for guests’ use. Guests have locks on their bedroom doors to give them more privacy which can be opened from the outside in the event of concern about the guest’s safety. Rooms vary in size and shape so guests can choose a room that suits their own personal tastes. Communal rooms were all seen and the standard of cleanliness throughout the house was observed to be adequate. Both guests said they were satisfied with their bedrooms but one requested more clothes storage space and this request was passed on to staff by inspectors. The conservatory is the designated smoking area so the rest of the house is smoke-free for guests. Laundry facilities are available. Arbours Crisis Centre DS0000027800.V338346.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, 33, 34, 35 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff employed to work with guests include the manager of the Crisis Centre, resident therapists and team leaders. The team leaders are responsible for the care plan, assessments and therapy programme of guests and the resident therapists are responsible for day to day support and care, as well as being part of the therapy team. Each team consists of the team leader, a qualified psychotherapist, a resident therapist who is training with Arbours and the guest. The manager is also a psychotherapist. Staff are therefore well equipped to carry out the aims of the Centre and offer intensive psychotherapeutic work with the guests. There is no waking night cover provided at the Centre. If guests need help during the night, they go and wake up one of the resident therapists. This happens on a regular basis. After a suicide at the Centre in April this year, CSCI asked Arbours to consider providing night time staffing to support guests with their needs at night. Arbours have responded that they do not think this is necessary. However, it is clear that some guests do need support during the Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 24 night and night time is a higher risk time for self harming. One guest described a current need for support during the night and records of recent regulation 37 reports of incidents showed that staff have to wake up in the night to assist guests. The guest was able to describe the pros and cons of having waking night staff to the inspectors. A recommendation is made to reconsider the best way to address night time needs and this will be followed up at the next inspection. The rota was inspected and showed that there are always two staff in the centre at all times, often there are more when the manager is on duty and when therapy sessions are taking place. Resident therapists have time off at weekends and cover staff come in. This was discussed with a resident therapist who said that guests cope well with this arrangement. A sample of staff files were inspected for evidence of a thorough recruitment process. These showed that Arbours had obtained two references and a Criminal Records Bureau check. Inspectors did not check the files of all the cover staff who cover for the resident therapists at weekends, so it is expected that Arbours will have ensured that two references and a CRB check are in place for these people before they are allowed into the Centre. Staff receive a good level of supervision regarding their work but these records were not inspected on this occasion. Currently there is no formal induction training for resident therapists and cover staff. This failing has been highlighted by Arbours and a series of induction training meetings are underway. A requirement is made to ensure that a written induction training is devised to ensure that all staff are fully aware of all their responsibilities when they are on duty. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 25 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, 42 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Guests benefit from a well run centre where their views are considered and where self monitoring takes place. Their health and safety will be better protected as the Centre improves health and safety and fire precautions. EVIDENCE: The manager has a psychotherapy qualification and has shown a good level of competence at the centre, affecting various improvements in recent months and is discussing the requirement for management training. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 26 There have been improvements in the management of the centre with regard to record keeping in the last year. The inspector saw records of regular meetings regarding the guests and the running of the centre as well as meetings of the management committee. These showed a good level of self monitoring. Ex guests of the centre are given questionnaires to complete to help with the continual monitoring of the quality of service provided. The centre has a strategic development plan which the inspector had the opportunity to read in January 2007. This showed evidence of forward planning and had targets for the next few years, showing a clear sense of direction. One of the requirements in the statutory requirement notice served on Arbours in May 2007 was regarding the reporting of incidents affecting the wellbeing of guests to the CSCI. This was due to a failure to report an attempted suicide. There has been a recent increase in the number of events reported and an improvement in the quality of the reports. This is positive. One recent incident had not been reported, and whilst appreciating that this was an oversight as the incident resulted in no harm, a requirement is made to ensure all incidents affecting guests are reported to CSCI. Fire safety was looked at in detail on this inspection, including examination of the centre’s fire alarm and equipment test records, a sample of the monthly fire safety inspections carried out by the Arbours’ fire safety officer for April and May 2007 and a tour of the building looking at fire safety issues. Improvements made over the last year are; developing a fire risk assessment, repairing faulty emergency lighting and installing a new fire alarm and detectors system. The last recorded fire drill was in May 2007 and these have been taking place on a regular basis. There were some ironing boards near to fire lobby doors outside bedrooms and staff were asked to move these items so that they do not obstruct people if they need to get out quickly in the event of a fire. The centre has a contract with a company to inspect and service the fire alarm system and equipment which is positive and the fire extinguishers were checked in November 2006. However, it was not evident that the company had inspected the emergency lighting so a requirement is made to ensure this is undertaken as soon as possible. It is the responsibility of staff at the centre to test the fire alarm each week. Records showed this had been taking place. A new fire emergency plan has been produced and displayed on the wall to ensure people living and working at the Crisis Centre are aware of the procedure to follow. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 27 The electrical wiring had been worked on and inspected in May 2006 and the certificate stated that it should be reinspected in one year. This had not taken place so a requirement is made to ensure this is done. In addition, there was no evidence of testing of the portable electrical appliances in the home so another requirement is made to ensure this is undertaken to ensure safety of these items. The boiler had passed its annual service in January 2007 but the gas cooker had not been serviced so this needs to be undertaken too. Following the death of a guest in April 2007, a requirement was made by the CSCI that Arbours undertake a risk assessment to ensure the safety of guests. This included an assessment of staffing levels and procedures as well as the physical environment. This was carried out. A checklist had been produced so that this health and safety risk assessment is updated monthly. During the tour of the building, inspectors noted that some windows had window restrictors so that they could not open fully and others did not. One guest had recently climbed out of a window when the restrictor was removed and it was noted that this had been replaced so that this could not happen again. However two other bedrooms had no restrictor and any guest could access these rooms. Inspectors were told that cover staff had removed the restrictors when they slept in these rooms. A requirement is ade to undertake a risk assessment on all windows in the home to assess whether a restrictor is needed. If one is assessed as needed, it must be in place. Inspectors were informed that the front door is locked at night and current guests do not have a key to it. This is done for the protection of guests who would be at risk if they went out at night. However, this does contravene fire regulations. A requirement is made to consult with the fire authority (LFEPA) to seek agreement for this arrangement. Evidence of this agreement must be sent to CSCI. Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 28 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 2 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X 2 2 x Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 29 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 YA9 Regulation 13(4) Requirement The registered persons must ensure risk assessments and risk management plans include specific strategies for addressing each risk identified for each guest. The registered person must provide evidence in the form of certificates that all staff who give out medication have attended training, which must be accredited. This requirement relates to a previous requirement that all staff attend accredited training. 3. YA20 13(2) The registered person must ensure that medication records are accurately kept with reasons why a medicine was not taken recorded on the chart. This requirement is restated. Previous dates of 30/01/07 and 11/05/07 not fully met. 30/07/07 Timescale for action 29/07/07 2. YA20 13(2) 02/08/07 Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 30 The reasons must be recorded on the MAR chart rather than any other document. 4. YA20 13(2) . The registered persons must ensure all medication entering the home is recorded as well as medication returned to the pharmacist for disposal so that there is an accurate record of medication stock at all times. The registered persons must also ensure the medication cabinet is properly monitored on a regular basis, and must not: • • • contain medication no longer in use contain excessive stocks of medication contain medications past their expiry date (and therefore a risk to guests). 02/08/07 5. YA19 13(1)(b) 6. YA35 18(1)(c)(i) The registered persons must 29/07/07 ensure that no nursing care is provided by staff employed by Arbours at any time. If any nursing care is required, this must be arranged through a GP practice nurse or District Nurse service. 30/09/07 The registered persons must provide a formal written Induction training programme for all resident therapists and cover staff to ensure they are aware of all their responsibilities. The programme should include basic knowledge of the National Minimum Standards for care homes and the Care Homes Regulations 2001. DS0000027800.V338346.R01.S.doc Version 5.2 Page 31 Arbours Crisis Centre 7. YA41 37 8. YA42 9. YA41 10. YA42 11. YA42 12. 13. YA42 YA42 The registered persons must ensure all events listed in Regulation 37 of The care homes regulations 2001 are reported to the CSCI at all times. 13(4)(a) The registered persons must ensure irons and ironing boards are not stored on landings and are removed to a safer place. 17 The registered persons must review all policies and procedures, update as necessary and ensure these comply with national minimum standards and the Care Homes Regulations 2001. 23(4)(c)(iv) The registered persons must ensure emergency lighting is inspected and certified in good working order. 23(2)(c) The registered persons must ensure all portable electrical appliances in the home, including personal items belonging to resident therapists and guests are tested for safety by a qualified electrician and evidence of this testing sent to the CSCI. 23(2)(c) The registered persons must ensure the gas cooker is serviced. 13(4)(c) The registered persons must include windows in the environment risk assessment for the home and record whether or not a restrictor needs to be in place for each window. Where it is assessed that a restrictor is needed, these must be in place. 29/07/07 02/08/07 30/10/07 02/08/07 02/08/07 02/08/07 29/07/07 14. YA42 23(4)(b) The registered persons must DS0000027800.V338346.R01.S.doc 29/07/07 Page 32 Arbours Crisis Centre Version 5.2 15. YA42 12 37 consult the fire authority (LFEPA)to seek advice regarding current practice of locking guests in at night for their safety. Evidence of the fire authority’s decision about this practice must be sent to CSCI. The registered persons must 02/08/07 revise the procedure on action to be taken in the event of a serious incident to make explicit what immediate action is to be taken and when to notify a guest’s placing authority, the police and the local authority for adult protection purposes. 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 YA26 YA33 Good Practice Recommendations Extra clothes storage space should provided to one guest as requested. The registered persons should consider whether current practice best meets guests’ night time needs and whether alternative staffing arrangement may better meet the needs of both guests and current resident therapists. The registered persons should adhere to the guidelines for use of medicines in Care Homes and seek the advice of their pharmacist regarding improving the management of medication in the home. 3 YA20 Arbours Crisis Centre DS0000027800.V338346.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 - 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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