Inspection on 21/11/05 for Lexham House

This inspection was carried out on 21st November 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lexham House 23/06/08

Lexham House 18/06/07

Lexham House 05/06/06

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 Unannounced Inspection 21st November 2005 2:15P Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lexham House Address 28 St Charles Square North Kensington London W10 6EE 020 8969 8745 020 8969 8745 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 Mr Alfredo Felices Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11) of places Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th June 2005 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 help 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 8PM until 9AM. Service users therefore need to be relatively self-managing. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place on Monday 21st November 2005 from 2.15PM until 6.15PM. There was initially 1 service user in the house and 3 staff on duty. A DiPSW student was also present. Other service users returned during the afternoon. In total there were 7 service users resident at Lexham House. There was 1 vacancy, with another room shortly to become vacant and 2 service users were in hospital. The Inspector spoke with 3 service users and with 3 staff. A service user showed the Inspector around the building. The Manager and Deputy were attending a monthly all day management meeting at CHT head office. The Manager phoned during the afternoon and spoke with the Inspector. What the service does well: What has improved since the last inspection? What they could do better: The staff team has undergone a number of changes of personnel and lacks cohesion. The improvement in the standard of hygiene and cleanliness noted at the annual inspection earlier in the year has not been maintained. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 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. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 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.V265014.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 and 5 Lexham House has a well established admissions procedure, involving service users and staff, that allows all parties to arrive at a considered decision. Detailed information is obtained about each service user before their admission on a trial basis. EVIDENCE: The files of 3 service users were looked at, including one person who had been admitted since the last inspection visit. Each contained a full assessment and showed that the admission had taken place with the support of the relevant multi professional team. Since the last inspection 2 people had been admitted to the project, one placement was progressing satisfactorily, while a decision had been made to terminate the other placement at the end of the trial period. A signed contract was available on each of the files seen. Standards 1 and 3 were not looked at during this visit but were fully met at the previous inspection. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Service users are fully involved in their care planning and reviews. One of the strengths of Lexham house is the extent to which service users are supported to take responsibility for themselves and fellow members of the community, to manage their mental health problems and to work towards living in a more independent setting. Risk assessments continue to be well written and regularly updated. EVIDENCE: Two of the 3 service users’ files seen contained a therapy plan/care plan, which had been regularly reviewed. No therapy plan was on file for one service user who was admitted on 1st August, nor could a copy be found on the IT system. The key worker was not on duty so was unable to clarify the absence of the plan. As the service user had been living at Lexham House for over 3 months and also had a forensic history, a plan detailing how this person was to be supported should have been available. Records and discussion with staff and with service users show that plans are in hand for 2 long stay service users to move on to more independent accommodation next year. All risk assessments were fully completed and up to date. Each file seen contained a signed agreement regarding confidentiality. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 10 The log book shows that community meetings take place regularly, though attendance by some service users is uneven. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 15, 16 and 17 The focus of the treatment programme at Lexham House is to support people to develop the ability to live independently and to manage the symptoms of their mental health problems. Participation in therapy and task groups within the home and in community activities form the key elements of this programme. Good use is made of local resources. Contact with families and friends is well supported. Improvements in the quality of meals and an emphasis on healthy eating has been maintained. EVIDENCE: The therapy programme has been revised to encourage a higher level of participation from service users. The number of service users regularly living in the house was lower than normal for a variety of reasons and staff were having difficulty motivating some people to take part in both community meetings and task groups. Service users continue to take part in a variety of activities in the community, including those designed for people recovering from mental illness. A number of service users regularly stay with their families. One service user was expecting a visit that evening. It was the birthday of one service user, who was being visited by family later in the week. Staff had bought him a present and a birthday cake. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 12 Service users take turns to cook the evening meal. The person responsible on the day of the inspection visit, returned from shopping with a supply of fresh fruit and vegetables, with which she made a vegetable curry. Staff have planned a weekly cooking group, as a number of service users are not ready to cook a meal for the community on their own. The service user making the meal was managing with a very limited number of utensils and it is recommended that additional equipment be purchased, in particular some large saucepans. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 Service users receive psychological support through the community meetings and regular sessions with their key worker. A number of service users have successfully been supported to move on to a more independent lifestyle. The importance of service users taking their medication regularly and eventually becoming responsible for their own medication is given a high priority. EVIDENCE: Service users are encouraged to take responsibility for their own physical health, as well as their mental health, and are registered with one of the local GP practices. Records show that there is regular contact with Psychiatrists and CPNs. Staff support service users to attend appointments with health care professionals where necessary. On the day of the inspection, a member of staff had accompanied a service user to visit the Dietician. MAR sheets seen were fully completed, using the standard codes. A number of current service users were refusing medication. This was noted and the Care Manager/CPN informed. Where one service user had recently become self-medicating, this was not noted in the risk assessment, nor was there a record of an assessment prior to the decision being made at the review. While the appropriateness of the decision, which was agreed by the supervising Psychiatrist, is not questioned, Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 14 the process of arriving at the decision to support the service user to become self-medicating should have been fully recorded. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users are encouraged to voice their concerns and complaints at community meetings. The complaints procedure recognises that issues may arrive which cannot be resolved within the house. Staff are familiar with local multi-agency adult protection procedures, as well as having in- house training. EVIDENCE: Signed copies of the complaints procedure were seen on service users’ files. The complaints book showed that no complaints have been received since the last inspection visit. Records of community meetings show that steps are taken to try to resolve disagreements and disputes. The Manager has ensured that staff attend regular adult protection training with RBKC. Incidents are fully recorded. Copies are sent to CSCI and the Deputy Director of CHT reviews all incidents at her monthly visits. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30 The building is spacious, with most bedrooms of above average size. Lexham house is well located being close to public transport and local services. The standard of decoration has improved, with much of the building recently redecorated. Improvements in cleanliness noted at the last inspection have not been maintained. EVIDENCE: A service user showed the Inspector around the building. Since the last inspection, much of the house has been redecorated and 3 of the bathrooms have been refurbished. New floor covering has been fitted in the entrance hall. The dining room and sitting room were pleasantly furnished and clean and tidy. The dining room curtains need replacing as they cannot be drawn and are hanging off the rail. Some areas of the house, in particular the dining room and stairs were cold on the day of the inspection. All service users were wearing their jackets and 2 commented on the low temperature. Staff said that the problems regarding heating the building had been reported. A large pile of clothes was covering the laundry floor, with other clothes and washing on top of the machines. Steps must be taken to ensure that service users’ laundry is kept separate to prevent cross infection. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 17 The Inspector saw 2 service users’ rooms, with their permission. One service user had clearly made her room her own space, with evidence of her possessions, photos and interests. The other bedroom seen indicated that the service user needed more support to maintain a minimum standard of comfort and cleanliness. The room was very untidy. The bed had no top sheet and a dirty sleeping bag was being used as a duvet. Staff explained that the service user needed constant reminding to wash his clothes and bedding. It was thought that his sheets were in the pile on the laundry floor. The fridge in the main kitchen needed cleaning. Cooked food must be kept covered and should be dated. The kitchen ceiling needs cleaning as accumulated dust is at risk of dropping into food. The bin in the basement kitchen had no lid and needed emptying. In discussion staff said that they are finding it difficult to motivate the current group into keeping the house clean, with cleaning and clearing up left to a small number of staff and service users. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 36 All staff take part in the well-established training programme, which is externally accredited. Sound systems of support and supervision are in place. The team is undergoing a number of changes and has lost some cohesion. EVIDENCE: Since the last inspection a number of staff changes have taken place: a new Deputy Manager is in post, 1 member of staff is on maternity leave, 1 new Therapist has started and 2 staff are in the process of moving on to other projects. The Manager said that 2 Apprentice Therapists have been appointed, for whom CRB checks are awaited. The changes in staff have resulted in difficulties in covering rotas and ensuring that staff are able to attend sufficient community meetings. Regular relief staff continue to be used at weekends and unusually for Lexham House, some agency staff have had to be used during the week. The most recently recruited member of staff confirmed that she had only been appointed following a thorough recruitment process. The changes in the staff team, its size and relative inexperience must be taken into account when considering new service users for admission. Staff confirmed that they receive weekly supervision, which is recorded. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41, 42 and 43 Staff recognise the importance of keeping accurate records. CHT has comprehensive policies and procedures, which are clearly written. Health and safety has been given a higher priority, with all staff attending training this year. Senior staff from the organisation visit regularly and are accessible to staff. EVIDENCE: In the absence of the Manager and Deputy Manager the day to day management of the home was not inspected. The Director and Deputy Director of CHT were taking steps to address some concerns raised by staff. The Manager has recently applied for registration. Records seen were in good order. Staff use the log book for day to day recording, though as this is hand-written it can be difficult to follow. Information in the log book is not transferred to service users’ individual files. Consideration could be given to keeping individual sheets for each service user. Portable electrical equipment appears to remain unchecked, though staff said that an electrician had recently been undertaking work in the house. Staff were observed to ensure that fire doors were kept shut. Issues regarding cleanliness and hygiene are discussed elsewhere in this report. The log book Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 20 shows that the Health and Safety Manager continues to carry out 3 monthly checks of the building. The Deputy Director visits the service at least monthly. Copies of her detailed reports are forwarded to CSCI. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 4 3 Standard No 2 2 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 2 4 x 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lexham House Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x 3 2 3 DS0000010845.V265014.R01.S.doc Version 5.0 Page 22 NO 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. 2. Standard 6 20 Regulation 15 13 Requirement Timescale for action 31/12/05 3. 30,42 13 4 33 18 A therapy plan/support plan must be available for each service user. Where a decision is made that a 31/12/05 service user is to be selfmedicating, the assessment leading to this decision must be fully recorded and the risk assessment reviewed. The laundry room must be kept 31/12/05 tidy, with service users’ unwashed clothing kept separate to prevent cross infection. The stability and experience of 31/12/05 the current staff team must be taken into account when considering the admission of new service users. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 41 Good Practice Recommendations Ways of ensuring that all relevant information is DS0000010845.V265014.R01.S.doc Version 5.0 Page 23 Lexham House transferred to service users files should be considered. Lexham House DS0000010845.V265014.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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