Inspection on 18/06/07 for Lexham House

This inspection was carried out on 18th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lexham House 23/06/08

Lexham House 05/06/06

Lexham House 21/11/05

Lexham House 27/06/05

Lexham House 18/10/04

Lexham House 02/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Lexham House 28 St Charles Square North Kensington London W10 6EE Lead Inspector Sheila Lycholit KeyUnannounced 18th June 2007 10:45 Lexham House DS0000010845.V339106.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 Lexham House DS0000010845.V339106.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. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lexham House Address 28 St Charles Square North Kensington London W10 6EE 020 8969 8745 020 8696 8745 chtlexham-uk@yahoo.co.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) Community Housing and Therapy Amer Si Mohand Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11) of places Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th June 2006 and 21 February 2007 Brief Description of the Service: Lexham House provides support and accommodation for 11 people with mental health problems, including psychosis. The service is provided by Community Housing and Therapy, which runs 6 projects for people with mental health problems. The home is run as a therapeutic community, which aims to support service users to move on to live independently or in supported housing. There are 9 single rooms and 1 double. The building is a 4-storey Victorian house in North Kensington, which is close to shops, public transport and other services. It is unsuitable for wheelchair use, as there are steep steps to all floors. There is single staffing from 9PM until 9AM. Service users therefore need to be relatively self-managing. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 18th June 2007 from 10.45AM until 5.30PM. The Deputy Manager was on duty with 3 support staff and 2 student Social Workers on placement. The Deputy Manager made herself available throughout the morning. The Manager returned from a meeting at CHT’s head office to take part in the inspection at about 1.30PM. Nine residents were living at Lexham House at the time of the inspection. There were 2 vacancies. One of the resident’s showed the Inspector around the building. Questionnaires were received from 3 residents and the Inspector spoke with 2 residents in private and met with a number of residents during the day. The Manager had completed an annual quality assurance assessment (AQAA) form in detail prior to the inspection. What the service does well: What has improved since the last inspection? What they could do better: While improvements in the administration of medication have taken place, all staff must ensure that they record medication with care. Further improvements in the physical environment would benefit residents and staff, including improved sleeping-in facilities. Staff are struggling to ensure that the building is kept in a reasonable state of cleanliness, as a number of the current residents have little awareness of their surroundings. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 6 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. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 7 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 Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 8 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, 3, 4 and 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Comprehensive information about the service is available. Lexham House has a well established admissions procedure, involving the existing residents and the staff team. EVIDENCE: Lexham House has a statement of purpose and service user’s guide that is printed off as required. In addition there is a range of leaflets available about CHT and its approach. The Manager said that he is considering the recommendation from the peer group review held in February this year that the service has a welcome pack for new residents. Three residents’ files were looked at during this visit. Each showed that steps had been taken to obtain as much information as possible about the resident, including discharge notes and the CPA care plan. The Manager normally visits the prospective resident in hospital or in residential accommodation and meets with the Mental Health Team before inviting the person to Lexham House. All prospective residents attend a meeting with staff and residents and normally make a number of visits to the project before a decision is made about their admission. Residents are sponsored by a wider number of London Boroughs than previously, which reflects the positive work that the Manager has carried out over the past two years in making Mental Health Teams more aware of the service and its suitability for clients with psychosis. All of the files seen contained a licence agreement. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 9 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 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents of Lexham House receive a high standard of professional support from staff and in addition benefit from participating in the therapeutic community and all aspects of life at the home. Risk assessments are comprehensive and well written. EVIDENCE: Care plans or therapeutic curricula seen were comprehensive, based on the assessment and showed evidence of the resident’s involvement. The Deputy Manager confirmed that all residents are given a copy of their care plan. Records show that care plans are regularly reviewed and updated, with the full participation of the resident. Discussion with staff and records show that Lexham House works closely with mental health colleagues and adopts a multi-professional approach to supporting residents. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 10 Residents are supported through the daily community meetings held each morning, regular 1:1 therapy sessions with their key worker and through participation in a range of practical groups in which staff also take part. A high standard of risk assessments has been established. Risk assessments are reviewed at least monthly. At the time of the inspection, the service had admitted a resident who was displaying sexually disinhibited behaviour. At least 6 incidents had occurred in spite of the resident being sent a letter warning him that he would be asked to leave if his unacceptable behaviour continued. The Deputy Director had visited the project the previous week to assess the suitability of the placement and to agree an action plan. A review meeting with the Mental Health Team was to take place 2 days after the inspection. New residents sign an agreement waiving their right to confidentiality, as all information can, in theory, be disclosed to the group. Staff are expected to abide by the normal rules of professional confidentiality. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 11 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): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents receive a high level of support to manage their mental health issues and to acquire both emotional and practical resources to take part in the wider community. The service has an excellent record of enabling residents with long term mental health needs to move to a more independent lifestyle. EVIDENCE: Community meetings and individual therapy give residents the opportunity to deal with longstanding psychological issues and to develop ways of managing their mental health needs. The task groups, such as cleaning, shopping and gardening, provide opportunities to learn day to day living skills, as well as contributing to the maintenance of a pleasant environment. Two long-term residents have successfully moved to more independent accommodation in the past 12 months and another resident has just been offered accommodation near his family. In addition to in-house groups, residents take part in external activities, including day services for people with mental health needs, adult education Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 12 and leisure services. One resident was about to start a work placement arranged through Business in the Community. Some reasonable restrictions and house rules are in place. All residents agree to a regular room search and some residents are subject to restrictions under the Mental Health Act. Staff encourage healthy eating with varying degrees of success. A weekly cooking group takes place for residents with few skills in preparing food. A rota of residents, assisted by staff, prepare the evening meal. The kitchen has been refurbished and the new larger cooker makes it easier to cook for larger numbers, as well as for several people to cook at the same time. Residents prepare their own breakfast and lunch. The evening meal is a communal occasion, which all residents, except those in the self-contained flat attend. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 13 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 and 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents receive very good psychological support from staff and from living in a therapeutic community. Staff encourage residents to adopt a more healthy lifestyle and to have regular health checks. Although senior staff have taken a number of steps to improve the administration and recording of medication, some poor practice noted at previous inspections continues. EVIDENCE: Residents do not need help with personal care, other than some prompting regarding hygiene. The Manager has allocated more staff time to some residents who require encouragement and supervision regarding personal hygiene, laundry and keeping their rooms in an acceptable state. All residents are supported to register with one of the local GP practices. Staff encourage residents to take care of their health, as part of their recovery programme. Steps have been taken to improve the recording and administration of medication. All staff have received in-house training from the Deputy Manager using the Boots training pack. The Deputy Manager has re-ordered the Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 14 medicines cupboard, which now includes lists of appointments for blood tests and Depo injections. Medication is checked at handovers so that any errors can be quickly rectified or noted. In spite of the higher profile given to the accurate administration of medication, the use of Tippex and failure to note the reasons for giving medication prescribed ‘as required’ noted at the previous inspection in February 2007 have continued. Two residents were self-medicating at the time of the inspection as part of their move to independent living. Procedures are in place to monitor residents who self-medicate. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are encouraged to express their views and concerns in the daily community meetings. Incidents involving residents are well recorded and staff are open about discussing concerns with CSCI and with Social Workers and Care Managers. Action taken in response to complaints must be fully recorded. EVIDENCE: All residents receive a copy of the complaints procedure when they move to Lexham House, which is confirmed on file. While most issues are resolved through community meetings, staff must ensure that complaints are logged, with a record made of action taken. Although no complaints were noted, a letter of complaint was seen on one resident’s file. Notes of community meetings indicated that the matter had been resolved. In discussion and in written feedback, residents confirmed that they were aware of how to raise concerns and complaints. No POVA investigations have taken place in the past 12 months. Incidents involving residents are well recorded and the relevant agencies informed. In the written feedback from residents, two people commented on the difficulty experienced by some staff in asserting themselves with residents. This may need further exploration with staff and residents to ensure that residents feel safe regardless of which staff are on duty. Consideration should be given to staff attending the safeguarding adults training programme offered by RBKC. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 16 Staff, in agreement with the relevant Care Managers, were taking steps to help two residents with gambling problems to better manage their money, in one case by taking over appointeeship. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27,28 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. A programme of refurbishment has taken place at Lexham House, which has resulted in a number of improvements. At the time of the inspection, staff were struggling to motivate sufficient residents to maintain the house in a reasonable state of cleanliness. EVIDENCE: The physical environment at Lexham House has improved over the past two years, with a programme of redecoration and refurbishment. A date for further decoration to be carried out had been agreed for the end of June. The current group of residents contain a number who have been institutionalised or who have been homeless and who seem unaware of their surroundings. Cleaning groups have been increased to 6 times a week in an attempt to improve the standard of cleanliness and the appearance of the communal rooms. In view of the current problems in maintaining an acceptable level of cleanliness, the Manager was considering introducing an evening cleaning schedule. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 18 The back garden is clear of rubbish but has become overgrown and steps need to be taken to make it usable. Bedrooms at Lexham House are of a good size and residents are provided with suitable furniture and bedding. The double room has sufficient furniture but was being shared by two people with limited skills in self-care and was very untidy. Staff were assisting one of the occupants to clear up the rubbish which had accumulated over the weekend. The staff sleep-in room has been made more comfortable with the provision of a bed rather than a sofa bed. Staff who sleeping-in have no en suite facilities and have to use the adjacent ground floor bathroom. It is unacceptable for female staff, who are on duty alone, to have to use communal facilities, particularly at the present time, when a male resident is displaying inappropriate sexual behaviour. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 19 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 and 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff training and support is given a high priority and staff are provided with an excellent training programme. EVIDENCE: The staff team is composed of a Manager, Deputy Manager and 8 support staff, who are designated as Therapists or Apprentice Therapists depending on their qualifications and experience. The majority of staff are on duty from 9 to 5 with 2 staff on duty from 5 to 9PM and 1 sleeping-in. Regular bank/agency staff are sometimes used at weekends. Staffing levels in the evening and overnight mean that the project is not suitable for clients needing monitoring or support during the night. A more formal handover has been introduced to ensure that essential information is passed on. Turnover of staff in the previous 12 months has been high with 7 staff leaving, though a number moved to other CHT projects as part of their own professional development. All posts are now full and feedback from staff at the inspection indicated that staff felt well supported. New staff are recruited by the Manager and head office staff who carry out all checks. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 20 CHT gives a high priority to staff training, support and supervision. Therapy staff are enrolled on a 3 year Diploma in Group Therapy, which includes placements in mental health units. The Diploma is accredited by Middlesex University. The Deputy Manager is studying for a MA at the Tavistock Clinic. New staff undertake induction training, which includes health and safety, at CHTs head office. In discussion new staff said that they enjoyed this training as in addition to the content of the programme, it gave them an opportunity to meet staff from other projects. Staff confirmed that they received weekly supervision, attended a weekly business staff meeting and a meeting to look at staff dynamics. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service is run by a well qualified and competent Manager, who in turn receives good support from his line Manager, the Deputy Director. CHT must take steps to ensure that new Managers apply for registration without delay. Recording is of a high standard. A range of quality assurance systems are in place. Although staff are more aware of health and safety issues, some essential work had not been followed up. EVIDENCE: The Manager is a qualified and experienced Psychologist, who regularly updates his training and knowledge. An application for registration has still not been received, although the Inspector was assured this would be completed the next day. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 22 As discussed above, staff commented on the support they receive from the Manager and Deputy Manager and through the system of staff meetings and de-briefings. A peer group audit, which included service users, took place in February this year, though the Manager had still not received a copy of the report. CHT is taking part in a number of research projects, including following up former clients. The review of policies and procedures being undertaken by the Deputy Director is nearing completion. Recording is generally of a high standard and senior staff regularly review the effectiveness of recording. Attention is paid to health and safety issues and steps have been taken to ensure that all new staff receive training during their induction period. A monthly health and safety check is carried out. Staff and residents using colour codes cloths, mops and buckets for cleaning to prevent cross infection. Fire safety is of particular importance at Lexham House as the majority of residents smoke. Fire drills take place regularly and are recorded in detail, with action taken. The maintenance record showed that a number of smoke detectors needed to be replaced, though this had not been followed up. Staff were unclear of the effect of new legislation on the smoking policy at Lexham House. Previous reports of checks of the water safety were available but no report for 2006 or 2007 could be found. The Manager contacted the Inspector later in the week to confirm that a report for 2006 was available. In view of the current behaviour of one resident, it is recommended that sufficient personal alarms are available for all staff. The Deputy Director visits at least monthly on behalf of the provider and copies her detailed reports to CSCI. The Manager provides a range of information to CHT’s head office for monitoring purposes. Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 23 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 3 4 4 5 3 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 2 25 3 26 3 27 3 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 4 3 3 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score N/A 3 2 N/A 2 3 3 3 3 2 3 Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 24 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 YA20 Regulation 13 Requirement As stated in the previous inspection report, Tippex must not be used on MAR sheets. The Manager must ensure that his application for registration is completed straightaway. The reason for administering medication prescribed as required, PRN, should be noted on the reverse of the MAR sheet. Steps should be taken to ensure that staff sleeping-in are provided with en suite facilities. The garden, although clear of rubbish, remains overgrown and needs to be made usable. Work identified by the fire safety contractor must be undertaken promptly. Checks of water safety must take place at least once a year. Timescale for action 31/07/07 2. YA37 9 30/06/07 3. YA20 13 31/07/07 4 5 6 7 YA28 YA24 YA42 YA42 23 13 13 13 31/12/07 31/07/07 31/07/07 31/07/07 Lexham House DS0000010845.V339106.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA23 YA23 YA42 Good Practice Recommendations Participation in the local safeguarding adults workshops should be considered. Issues raised in residents’ feedback concerning the ability of some staff to assert themselves would benefit from further exploration. Consideration should be given to providing all staff with personal alarms. 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