Inspection on 27/06/05 for Lexham House

This inspection was carried out on 27th June 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 found no outstanding requirements from the previous inspection report, but made 3 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 18/06/07

Lexham House 05/06/06

Lexham House 21/11/05

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 Announced 27 June 2005 10:15 AM The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lexham House Address 28 St Charles Square, North Kensington, London W10 6EE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8969 8745 020 8969 8745 Community Housing and Therapy Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (11) of places LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18 October 2004, an additional visit took place on 15th March 2005 Brief Description of the Service: Lexham House provides support and accomodation 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 G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection visit took place on 27th June 2005, from 10.15AM to 3.45PM. The Manager, Amer Si Mohand, made himself available throughout the visit and completed pre-inspection information on the service. There were 9 service users living at Lexham House at the time of the inspection, of which 8 were male and 1 female. One service user was in hospital and the home had 1 vacancy. A service user showed the Inspector around the building. Six comment cards were received from service users, 1 from a Consultant Psychiatrist, 1 from a CPN and 3 from Care Managers/Placement Officers. What the service does well: What has improved since the last inspection? What they could do better: 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 G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 5 The statement of purpose and service user guide provide prospective service users and referring agencies with relevant information about Lexham House and its therapeutic approach. There is an established admission procedure involving existing service users and staff that allows a considered decision to be reached by all parties. EVIDENCE: The statement of purpose remains in the same format as at previous inspections but has been updated to reflect the current deployment of staff in the evenings and overnight. In addition there is an illustrated brochure of Lexham House. All prospective service users visit the home for a number of formal and informal meetings with residents and with staff. New service users have a 6 week trial period before a decision is made by the community and themselves about their continued stay. The case records of 4 service users were seen. Each contained an assessment by the relevant mental health team and a signed copy of a contract with CHT. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 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 are comprehensive and well written. EVIDENCE: Care plans on the 4 individual files seen, were detailed and up to date. Files show that reviews take place regularly and that additional multi-professional meetings are called when a service user’s mental health appears to be deteriorating. Steps had been taken to encourage one service user, who was not taking his medication regularly or taking part in community meetings and activities, to comply with his contract. Service users are fully involved in the day to day running of the home. Their participation is a condition of their remaining at Lexham House, though staff expectations of their participation take into account their stage of recovery. Initial risk assessments are carried out by the referring Mental Health Team. Comprehensive risk assessments have been introduced by the current Manager. Risk assessments must be reviewed following an incident. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 9 Service users are aware that a condition of moving to Lexham House is that relevant information about their background will be shared with staff, other professionals and service users. Signed agreements to the release of information were available on each of the files seen. Service users are made aware that, while there is a policy of no confidentiality at Lexham House, they must not disclose any information outside of the house. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16,and 17 The focus of the treatment programme at Lexham House is to support people to develop the ability to live independently and to find ways of managing the symptoms of their mental health problems. The task groups provide opportunities to acquire daily living skills, needed for more independent living. Good use is made of local facilities, both those designed to support people recovering from mental illness and community leisure and adult education services. Contact with families and friends is supported. Steps have been taken to improve the quality of meals and to encourage healthy eating. EVIDENCE: Records show that service users are encouraged to develop the confidence to participate in community meetings, to take responsibility for themselves and to participate in the day to day household tasks. Discussion with service users showed that the support and activities programme noted in their care plan was being implemented, including attendance at the local Day Unit and at a drug rehabilitation course. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 11 Service users go out and about in the neighbourhood every day, using local services and facilities. Outings and events are arranged such as trips to the cinema and a date for a summer barbeque was being arranged. Service users have keys to the front door and to their rooms, which they were seen to keep locked. Weekly room searches are one of the conditions of admission. The log book notes visits from families and friends, which take place regularly. A number of service users go to stay with their families at weekends or for short breaks. Records show that steps are taken to prevent friends who do not respect the house rules from visiting. Menus have been revised, with more emphasis on using fresh produce and on healthy eating. Food shopping takes place daily. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 and 20 Service users are provided with psychological support through the daily community meetings, in individual sessions and through day to day interaction. Personal care is not provided and service users need to be able to manage their day to day care needs. The service is successful in supporting a number of service users to move on to a more independent life in the community. The importance of service users managing their medication is recognised and steps taken to encourage regular ordering and self-administration. Service users are supported to take care of their general health, as well as their mental health and to use relevant services. EVIDENCE: All service users are registered with one of the local GP practices and are encouraged to take care of their health. Each service user is in contact with a Mental Health Team and sees a Psychiatrist for follow up regularly. Staff accompany service users to appointments where necessary. Service users who are self-medicating hold their medication in a locked box in their room. Staff check medication to monitor that it is being taken regularly. Medication administered by staff is kept in a locked wall cabinet. One of the MAR sheets seen contained gaps. The standard codes must be used for nonadministration of medication. The notes of staff meetings showed that the Manager had recently reminded staff about not leaving gaps when recording medication administration. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Service users are encouraged to voice their concerns and complaints at community meetings, which are seen as the setting for resolving issues. The complaints procedure recognises that issues may arise which cannot be resolved within the house. Steps have been taken to ensure that staff are familiar with current adult protection policies and procedures. EVIDENCE: All service users receive a copy of the complaints procedure on admission and a signed copy is kept on their file. No complaints have been received since the last inspection. Incident records show that staff take prompt action to resolve disputes between service users and to prevent any physical assaults. Staff have recently attended protection of vulnerable adults training run by RBKC and have copies of the inter-agency policies and procedures. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,30 Action has been taken to improve the standard of decoration and to bring the maintenance of the building up to date. Lexham House is well located for public transport and local services. Most of the bedrooms are large and airy and there is sufficient communal and office space. More attention has been paid to the cleanliness of the building, which is much improved. EVIDENCE: A substantial programme of refurbishment of the building has started. The builders were present during the inspection visit. Two bathrooms have been refurbished and the builders had started work on the ground floor bathroom. The stairs are being redecorated, including re-plastered, a new kitchen is to be installed and the ground floor redecorated. Further work is to be carried out in the next financial year, which will include service users’ bedrooms. Staff plan to use the kitchen in the basement flat, while the main kitchen is being replaced. Two service users showed the Inspector their rooms. The room belonging to a long-standing service user had been furnished and equipped to her taste and needs. The carpet in the room of a recently admitted service user, although in LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 15 good condition, would have benefited from being cleaned/shampooed before the room was re-used. No mattress cover or towels were available. Some bedroom furniture has been replaced. A new sofa bed has been purchased for the sleeping-in room. The Manager has obtained an estimate for pruning the trees in the back garden. Cleaning is carried out daily, which has resulted in an improved level of hygiene, especially in the kitchen, where surfaces, cupboards and the fridge were much cleaner and tidier. Soap and disposable towels were available at all the washbasins. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 and 36 Staff receive comprehensive training in working with people with mental health problems and sound systems of supervision and support are in place. The staff complement of a Manager, Deputy and 5 support staff is relatively small for 11 service users, some of whom are at an early stage of recovery from mental illness and staffing levels need to be kept under review. EVIDENCE: Staff are recruited from a variety of backgrounds, most having a relevant degree or experience of working in a mental health setting. All staff as a condition of employment take part in accredited training leading to the Diploma for Therapeutic Community Practitioners. Staff complete a probationary period before being confirmed in post. The staff team will shortly undergo a number of changes as a result of internal promotion and maternity leave. Interactions observed between staff and service users were positive and service users commented on the support they received from staff. Staff rotas have been amended, following discussion with CSCI, to provide 2 staff on duty until 8PM rather than 5PM. In addition the Manager or Deputy assess the stability of the community before going off duty. The Manager confirmed that in response to one incident a second member of staff had LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 17 remained on duty until 12AM to ensure one service user was settled. A small number of ‘bank’ or agency staff are used, who know the service well. When considering new admissions, staffing levels and the experience of the staff team, as well as the needs of current service users, must be taken into account. Lexham House provides placements for Diploma in Social Work students. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41,42 and 43 The Manager, who took up his post in January this year, has provided the team with leadership and direction. With the support of senior staff in CHT the backlog of repairs and maintenance are being addressed and more attention has been given to health and safety within the home. EVIDENCE: The Manager is a Clinical Psychologist, experienced in staff management. He is applying for registration. Minutes of staff business meetings show that issues are taken up with staff and action agreed. It is recommended that minutes are typed and that staff sign to confirm they have read them. The service users records seen were up to date and in good order. Service users have access to their personal files and to the daily log where an entry on each person is made. Other records were also well kept. Policies and procedures are well written. Not all were dated, nor was a review date noted. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 19 An Officer from the London Fire Brigade visited on 17th May 2005 to talk to staff and service users about fire safety. He made a tour of the building, recommending a change to the door catch on one of the fire exits and that a different type of extinguisher be fitted in the kitchen. No report was available following this visit. Action to replace the fire extinguisher and change the door catch was in hand. Fire drills are carried out 4 times a year. The fire risk assessment was completed on 18th March 2005. It was unclear whether portable electrical equipment had been checked, as the equipment had not been marked with the date of the check. Since the last inspection, staff have attended health and safety training including Food Handling and Fire Safety. The Deputy Director of CHT visits at least once a month. Copies of her reports are sent to CSCI. Lexham House is a member of the Quality Network of Therapeutic Communities. No quality audit report for Lexham House was available at the inspection. CHT has applied for the Investors in People award. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 20 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 3 3 3 4 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 2 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 LEXHAM HOUSE Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 2 3 G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 21 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. Standard YA9 Regulation 13 Requirement Risk assessments are of a high standard but must be reviewed following any incident or accident. The standard codes must be used to record the nonadministration of medication. Staffing levels must be kept under review. Timescale for action July 31st 05 2. 3. YA20 YA34 13 18 July 31st 05 July 31st 05 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 YA40 YA42 Good Practice Recommendations Policies and procedures should contain an implementation date and date for review. Portable electrical equipment should be regularly checked, in accordance the fire risk assessment and marked accordingly. LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI LEXHAM HOUSE G60 - G09 S10845 LEXHAM HOUSE AIV223840 270605 STAGE 4.doc Version 1.30 Page 23 - 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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