Inspection on 05/06/06 for Lexham House

This inspection was carried out on 5th June 2006.

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 2 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 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 Unannounced Inspection 5th June 2006 10:20 Lexham House DS0000010845.V297899.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.V297899.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.V297899.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 lexham@cht.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 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 DS0000010845.V297899.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 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.V297899.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visit took place on Monday 5th June 2006 from 10.20AM until 3.45PM. The Manager and 3 staff were on duty. Ten service users were in residence, with one vacancy. When the Inspector arrived, the 3 staff and service users were taking part in the daily community meeting. The Manager made himself available throughout the day. The Inspector made a tour of the building, met with a number of service users, speaking with two in private and attended part of the staff supervision group. Service users spoken with were positive about their stay at Lexham House and the support they had received from staff. What the service does well: What has improved since the last inspection? A more stable and cohesive staff team has been established. Improvements in the appearance of the building have continued and the backlog of building maintenance has been almost completed. Fire precautions have been brought up to date. Policies and procedures throughout the organisation are being reviewed and updated. Lexham House DS0000010845.V297899.R01.S.doc Version 5.2 Page 6 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 DS0000010845.V297899.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.V297899.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5 and 6 The quality of outcomes for these standards is good. Detailed information is obtained about each service user before admission. There is a well established admissions procedure involving service users and staff, that allows all parties to reach a considered decision about the suitability of the placement. EVIDENCE: The files of 4 service users were looked at, including the person most recently admitted to the home. Each of the files seen contained a multi-professional assessment and most included a copy of the hospital discharge notes. Records showed that service users had visited the home on a number of occasions before being admitted. One service user had attended Lexham House for 2 days a week for a period to allow the service user, staff and other professional colleagues to assess whether the service would meet his needs. Service users are normally admitted for a trial period before the placement is confirmed. Each of the files seen contained a copy of a licence agreement signed by the service user. The statement of purpose and service users guide are kept on the PC and regularly updated. The Manager confirmed that no recent changes had been made. Copies were not seen at this inspection visit. Lexham House DS0000010845.V297899.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 The quality of outcomes for these standards is excellent. The strength of Lexham House and the therapeutic community approach is the support for service users to take responsibility for themselves and their fellow residents and to fully take part in all aspects of daily life of the house. Risk assessments are well written and are regularly updated. EVIDENCE: Each of the 4 individual files seen contained a detailed service user plan (therapeutic curriculum) that had been agreed with the service user and was regularly reviewed. Service users are always involved in their reviews, both within the home and with their Mental Health Team. Each service user has a key worker, with whom they have regular one to one sessions. Service users and staff take part in a daily community meeting. Plans are in hand for two long-standing service users to move to less supported accommodation. Both have been managing their own medication for some time and are self-catering. Staff are gradually withdrawing support to enable them to make more decisions for themselves and to adjust to being in an un-staffed setting. The standard of risk assessments has been maintained. All risk assessments for new service users are checked by the Manager. Lexham House DS0000010845.V297899.R01.S.doc Version 5.2 Page 10 The most recent copies of some risk assessments and reviews were not on file but the Manager was able to print them from the PC. Copies of signed copies of a confidentiality agreement were seen on each file. In the staff supervision group, staff were considering ways of trying to ensure the safety of a service user who was becoming unwell while respecting his right to confidentiality. Lexham House DS0000010845.V297899.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 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 quality of outcomes for these standards is good. Service users are helped to develop the skills needed to live independently and to manage their mental health through an established programme of group and individual therapy and through task groups. Contact with families and friends is well supported. EVIDENCE: In addition to group and individual therapy, service users are supported to take part in a range of activities outside of Lexham House, including adult education and day services for people recovering from mental illness. While some service users have good self care skills, others come to Lexham House unable to carry out even basic tasks. As well as taking part in the regular task groups, service users in need of additional help with daily living skills have been allocated a practical key worker. The regime at Lexham House is relatively flexible, although service users are expected to attend the 9.30AM community meeting and to take part in task groups and one to one therapy. Some service users are subject to restrictions under the Mental Health Act. All service users agree to regular room searches as part of their contract. These are undertaken by service users and staff. Lexham House DS0000010845.V297899.R01.S.doc Version 5.2 Page 12 Contact with family and friends is supported where appropriate. A number of service users regularly visit their families, sometimes staying overnight. Records seen indicated that families were kept informed of developments and significant events. In discussion 3 service users complained about the amount of money allocated for food, indicating that this resulted in shortages. A number of service users were said to attend the ‘soup kitchen’ provided by the church nearby. Service users take turns to shop for food, sometimes accompanied by staff. In discussion the Manager agreed that on the day of the inspection there was little food in the house, as the daily shop had not taken place and the service user who had been responsible for the previous day’s food shopping had spent little of the allowance. The Inspector saw a small amount of food in the fridge and there was some food in the freezer. The food budget is £32 a day, which is for 8 service users, as 2 people are self-catering and receive a separate allowance. This budget seems reasonable providing that it is fully used. The Inspector saw the standard shopping list, which includes fresh fruit and vegetables. Lexham House DS0000010845.V297899.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The quality of outcomes for these standards is adequate. Service users are well supported psychologically, through the system of group and individual meetings and by staff working closely with the multiprofessional team. Although the Manager is monitoring the administration of medication, poor practice in recording has continued. EVIDENCE: Service users do not need help with personal care, other than prompting and encouragement regarding appearance and personal hygiene. Service users are registered with one of the local GP practices and are encouraged to take care of their health needs. Records show that regular contact takes place with Psychiatrists and CPNs and service users are supported to attend appointments. Outpatient and clinic appointments for the day are noted on the white board in the main office. The administration of medication is monitored by the Manager weekly and errors raised at the staff meeting. However mistakes continue to be made: Tippex was used on 2 MAR sheets; a gap was noted on one record; the MAR sheet for 1 service user was missing and staff had recorded the medication given on a Post-it note. The Manager said that he was trying to find external training to raise the standard of medication administration. Lexham House DS0000010845.V297899.R01.S.doc Version 5.2 Page 14 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 The quality of outcomes for these standards is good. There is an established complaints system for handling complaints that cannot be resolved within the community at Lexham House. Links have been established with the local adult protection co-ordinator to enhance the organisation’s own training and procedures. EVIDENCE: Copies of CHT’s complaints procedure were seen on each of the 4 service users files. Service users sign to confirm that they have received a copy of the procedure. Community meetings are seen as the venue to discuss and resolve concerns, though the complaints procedure acknowledges that service users need the option of taking complaints to senior staff. The Manager confirmed that no formal complaints have been received since the last inspection. There has been 1 POVA strategy meeting following an incident. In discussion with the Inspector the service user confirmed that she was satisfied with the outcome of the meeting. Staff have attended training with RBKC and copies of the local multi-professional policies and procedures are available in the home, in addition to CHT’s own procedures. Incidents are well recorded and copies forwarded to CSCI. Lexham House DS0000010845.V297899.R01.S.doc Version 5.2 Page 15 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 29 The quality of outcomes for these standards is good. Improvements in the standard of decoration, maintenance and cleaning have continued, resulting in a more attractive and pleasant environment. The Manager has implemented a successful system of additional support for service users who have few self-care skills to ensure that other service users are not adversely affected. EVIDENCE: The Manager and senior CHT staff have taken steps over the past 18 months to improve the environment at Lexham House, through a programme of refurbishment and redecoration, as well as implementing a more thorough cleaning regime. Much of the redecoration and refurbishment has been completed, including the external painting of the house. A date in June for the kitchen to be replaced has been agreed. Two service users’ rooms and the vacant room were seen. The vacant room was clean and tidy and one service user’s room was highly personalised, with a large collection of possessions reflecting his interests. One room was very untidy with cigarette ash on the mattress. The Manager explained that this service user was receiving additional support with self-care and his smoking in his room was being carefully monitored. Lexham House DS0000010845.V297899.R01.S.doc Version 5.2 Page 16 A number of beds and mattresses have been replaced. Mattresses and other furniture were in the garden awaiting collection. On the morning of the inspection, communal areas of the building were a little grubby but this was soon rectified by the cleaning group, which included staff members. Lexham House DS0000010845.V297899.R01.S.doc Version 5.2 Page 17 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 The quality of outcomes for these standards is good. Steps have been taken to establish a more stable staff team and to improve its cohesion. All staff take part in a well established training programme that is externally accredited. EVIDENCE: A full staff team has been recruited. In addition to the Manager and Deputy Manager, there is a Senior Therapist who has recently returned from maternity leave, a Therapist and 3 Apprentice Therapists. The Manager informed the Inspector that CHT is planning to implement consistent staffing and a uniform rota across its residential establishments. As a result, Lexham House will receive an additional post. The new rota will allow for 2 staff to be on duty until 9PM. Improvements to staff terms and conditions have also been made. Records show that staff meetings take place weekly. These are recorded in detail and staff attendance is high. All staff are enrolled on a 3 year psychotherapy training programme, which is externally accredited. The programme includes external placements. Staff are recruited by CHTs head office, with the Manager sitting on the interview panel. The Manager confirmed that all staff have received satisfactory criminal record checks. Lexham House DS0000010845.V297899.R01.S.doc Version 5.2 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 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): 37, 38, 39, 40, 41, 42 and 43 The quality of outcomes for these standards is adequate. The home is run by a competent Manager, who is well supported by senior head office staff. However the provider must ensure that there are no further delays to the Manager making an application for registration. Recording is generally of a high standard and a higher priority is being given to health and safety issues. EVIDENCE: The Manager has been in post since January 2005. He is a Psychologist who is undertaking a post-graduate degree. The Manager has not completed his application for registration. The provider must ensure that an application for registration is made without further delay. The Manager said that he was well supported by the Director and Deputy Director to resolve problems in the staff team that occurred last year. The Deputy Director visits regularly, at least monthly and copies of her detailed reports are forwarded to CSCI. Lexham House DS0000010845.V297899.R01.S.doc Version 5.2 Page 19 CHT is a member of the Association of Therapeutic Communities and takes part in an annual external review, using the ATC service standards. The latest report is not available, although the Manager confirmed that the reviewers had visited the home earlier this year. A previous report was seen by the Inspector. Attention is paid to record keeping. A new system of keeping separate daily records for service users has been implemented. The Manager said that the home is taking part in a research project looking at recording. Improvements in health and safety have continued. The fire precautions have been updated following a visit by the London fire Authority in January this year. Work carried out includes the replacement of some internal doors and a new exit bolt on the side door, which is a fire exit. Records show that staff and service users have been trained to operate the new exit bolt. Fire points are tested weekly and fire drills take place at least 4 times a year. A fire drill is normally arranged following the admission of a new service user. The last drill took place on 28th May 2006. Records show that the fire detection system and fire fighting equipment is regularly serviced. A general health and safety risk assessment was completed on 17th January 2006. The standard of hygiene in the kitchen has improved with the introduction of colour coding to prevent cross contamination. The fridge was clean and tidy. Service users commented on problems with the boiler that had occurred earlier in the year. The Manager confirmed that the boiler had been out of action for 8 days, even though CHT has a contract for servicing and repairs. He is looking into ways of ensuring a more speedy response. Lexham House DS0000010845.V297899.R01.S.doc Version 5.2 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 Standard No Score 1 x 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 3 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 3 34 4 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 x 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 x 1 3 3 3 3 3 3 Lexham House DS0000010845.V297899.R01.S.doc Version 5.2 Page 21 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 YA20 Standard Regulation 13 Requirement Staff must receive training in the administration of medication, including refresher training. Tippex must not be used on MAR sheets. The Manager must apply for registration. Timescale for action 31/07/06 2 YA37 9 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lexham House DS0000010845.V297899.R01.S.doc Version 5.2 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 DS0000010845.V297899.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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