Inspection on 13/11/06 for London Mental Health Care Centre

This inspection was carried out on 13th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

London Mental Health Care Centre 24/04/09

London Mental Health Care Centre 06/05/08

London Mental Health Care Centre 01/10/07

London Mental Health Care Centre 19/12/05

London Mental Health Care Centre 09/06/05

London Mental Health Care Centre 19/05/04

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

CARE HOME ADULTS 18-65 London Mental Health Care Centre 78-80 Arran Road Catford London SE6 2NN Lead Inspector Unannounced Inspection 13th November 2006 10:45 London Mental Health Care Centre DS0000025631.V317183.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 London Mental Health Care Centre DS0000025631.V317183.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. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service London Mental Health Care Centre Address 78-80 Arran Road Catford London SE6 2NN 0208 6988770 0208 6988770 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) Mr Dhaneswar Dooraree Mr Dhaneswar Dooraree Care Home 15 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (15), of places Physical disability (1) London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 15 persons with a mental health problem, one of whom may also have a physical disability to include four persons who may also have a learning disability - see attached sheet for details 19th December 2005 Date of last inspection Brief Description of the Service: The London Mental Health Care Centre is a care home registered to provide accommodation and care to 15 adults with mental health problems. It is situated in a quiet side road off the Bromley Road approximately 15 minutes walk from the shopping centre and civic amenities in Catford. The home has 13 single rooms, and one shared room. There is a communal area for dining, and an activities area where there is a television and a pool table. There is a goodsized garden with patio area with outside seating. There is also a quiet room for private meetings of staff and residents The home aims to provide support and accommodation to residents who are undergoing rehabilitative care programmes. The skills that they acquire will enable them to move on to more independent living situations where possible. Accessing local services and integration with the wider community are an implicit part of the rehabilitation programme. The staff team includes a number of RMN’s and staff with NVQ qualifications. The weekly fees are between £ 700 - £1,300 .The pre inspection information stated no extra charges were applied. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over a period of one day by two inspectors. The deputy manager facilitated the inspection. The Registered Provider arrived mid way through the morning period although did not stay for the duration of the inspection. Throughout the inspection process, staff in the home including the deputy manger were helpful courteous and professional. Prior to the inspection the pre -inspection document had been completed that included supporting documentation such as the menu’s, staff off duty lists and a list of staff employees. The inspector sent out comment cards to members of the multidisciplinary team, residents and their relatives. At the time of the inspection one had been received with favourable comments related. Other comment cards were given out. At the time of the visit the inspectors met with three residents at length and others for a lesser time. There were no relatives or visitors in the home during the inspection period or members of the multidisciplinary team. The three staff on duty met with the inspector whilst the Deputy Manager facilitated the inspection process. A tour of the premises was undertaken including communal areas and some bedrooms. Some residents did not want the inspectors to view their bedrooms this was respected. The general routines of the home were observed including resident and staff related activities. Documentation, including resident’s care plans, staff personnel files as well as health and safety records were inspected. Verbal feedback was provided to conclude the inspection. What the service does well: The home provides accommodation and support to those residents with enduring mental health problems, many of whom have had numerous admissions to mental health facilities over a number of years. The home has established good links and professional working relationships with members of the multi disciplinary team. The home has been successful in providing rehabilitation skills enabling some former residents to move on to more independent accommodation. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. London Mental Health Care Centre DS0000025631.V317183.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 London Mental Health Care Centre DS0000025631.V317183.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): The quality rating in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are conducted prior to any admission although in some cases the information was limited in it’s content. Evidence of information provided to residents, and that received prior to placement including that obtained as a result of trail visits, was limited. EVIDENCE: The inspectors were advised that all of the current resident group are under Care Programme Approach either standard or enhanced, or under Section 117 aftercare. The assessment information of three residents was inspected that of a newly admitted resident and two of those who had been in the home a longer period. The organisation has developed a Service Users Guide and a Statement of Purpose, which provides information on the home to prospective residents or their representatives. Copies are also on display in the home for residents to view. The documents are basic and, in the case of the “Guide”, contains some of the information required by the Regulations. However, the Manager must ensure that Regulation 5 of the Care Homes Regulations is met particularly in relation to recent changes. The Guide does not include the terms and conditions nor arrangement for payment of fees or, if funded by someone else, what changes if any, this would mean to the terms and conditions. Please refer to the London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 9 amended Regulations for further information. Some of this information was detailed in the Statement of Purpose however this did not include all that is now required. The home provides the residents with contracts, terms and conditions of residency and a copy of the house rules, which must be signed for. These documents provide the residents with information on what is expected of them and the home. All admissions to the home are on a three- month trial period and the admissions process includes pre-admission visits by the prospective resident. The inspector viewed two residents’ files. One had been admitted recently and the other in 01/05. Neither contained any form of assessment completed by the home prior to the residents’ admissions. The file of the latest resident admitted did contain the latest CPA documentation, which reflected the resident’s current needs. The residents in this home have complex needs and the home must ensure full and comprehensive information is available from all those involved with the residents care prior to admission, The home should confirm this information through its own assessment records. Following the assessment the home must confirm in writing it’s ability to meet the assessed needs. The second inspector viewed the assessment information and care plan of a resident who had been admitted April 2002. Her assessment documentation included an assessment profile, however there was little in respect of other information received prior to placement .The assessment profile had some information although this was not comprehensive in it’s content. The inspector is aware that the requirements have changed since 2002 and more is now required, and accepts that those residents admitted some years ago will have less information on file than those recently admitted. Please see requirement 1. Please see recommendation 1. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 10 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): The quality rating in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and supporting risk assessments were in place, although did not fully reflect the complex and challenging needs some residents had. Risk assessments need to have comprehensive interventions detailed to reduce or eliminate the identified risks in order that staff can use the guidance effectively. EVIDENCE: The residents in this home are mobile and in the main physically able. There are no adaptations, hoists or lifts in the building, stairs access all areas. The care plan of the resident admitted April 2002 was inspected. The care plan covered problem areas including physical and mental health as well as rehabilitation issues. These were signed by the resident and the staff member. It was evident from the records that this residents suffers occasional incontinence, this was included in the section on personal hygiene although should be identified, as an issue in it’s own right. There was good information in respect of her agoraphobia and specific management instructions for this. The daily events referenced this although usually limited to statements such as ”did not go out”. More reference to the management information could have been included. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 11 There was good information recorded in respect of other health professionals’ visits and attendance at other related health appointments. Key worker sessions were recorded, as well as input from the psychiatrist occupational therapist and psychologist. There were records relating to Care Programme Approach (CPA) meetings. The risk assessment documentation was a statement of risk, although there were no interventions detailed on how to manage the identified risks. Some of these risks were however incorporated into care plans, where there was good information recorded. A second care plan was inspected again similar information was available. Reviews were in place at approximately three-month intervals although these were limited in their content. The second inspector viewed a care plan in relation to one resident. This contained information on a number of areas. However in the case of this resident there were gaps in the information. This included the support required in respect of the resident’s health needs’ namely a hernia problem, and weight issues. The information in the care plan was not very specific in some cases. The CPA had identified that there had been issues in the past with drug/alcohol misuse, however there was limited information in the current care plan regarding this, nor was there specific information in relation to allegations or accusations that may be made as a result of mental ill health. It was also difficult to determine what staff should look out for in the individuals deteriorating mental health condition and specific action to take. Since some of these staff are quite new and inexperienced, the information must be clear. Again there was evidence of regular CPA reviews with resident involvement and again the resident had signed the care plan. There was little evidence of any restrictions made on the residents in the individual care planning, although the home has its set of rules, which the residents are expected to abide by and sign to agree this. Some of the residents have the support of independent advocates whilst others are supported by their social workers or CPA co-ordinators and benefit from regular meetings. The pre-inspection questionnaire records stated that the home is not appointee to any resident. Discussions with one resident confirmed that they are responsible for their own finances and records show that they receive the benefits. The care plans did not detail what assistance residents’ needed in respect of budgeting and financial issues however there was statement of agreement in relation to staff assistance with financial affairs. This should be made clear. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 12 Please see requirement 2. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 13 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): The quality rating in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to develop rehabilitation skills with support from staff in the home. Recreational and social activities are provided both in house and in the local community. EVIDENCE: The inspectors met with several of the residents through out the inspection, of which three had discussions with the two inspectors individually. One resident was on his way to the gym, which he attends frequently. All residents are provided with freedom passes that enables them to travel free on public transport. He was quite satisfied with the home and the staff working in it. He felt that he was given choice and independence in his daily life During the inspection the staff were involved not only with the inspection process and residents needs but the heating system was being repaired. Residents were undertaking activities with the staff during the afternoon period although less so during the morning period. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 14 One resident commented to the inspector ,that she was unhappy at the restrictions placed upon her ,more specifically that of having to be back at the home by 12 midnight. The resident felt this was not appropriate although staff did clearly state the reasons that were in relation to the resident’s own safety due to her vulnerability. Visitors are welcomed to the home at any reasonable time and can see their relatives in private where appropriate. There is a lot of equipment in the home for the residents to use for recreational purposes including a pool table, TV,music centres and newspapers Meals are prepared either by residents with staff support or by the staff. Residents as part of rehabilitation do undertake sessions relating to budgeting, cooking and food preparation. The menus provided with the pre inspection information showed a varied menu There is a resident’s telephone with screening provided. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 15 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): The quality rating in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was good records in relation to health care provided through the multi disciplinary team. The medication storage, recording and administration are were well managed EVIDENCE: Healthcare is provided through the community services. As part of rehabilitation, residents are encouraged to attend these facilities. Those residents who are subject to CPA procedures have regular multidisciplinary meetings monitoring all aspects of health and risk . The residents have named psychiatrists as well as other members of the multi disciplinary team who are involved in their care package. Discussions with one resident showed that the home enables residents be independent and encourages them to prepare for living independently in the community. Many of the residents are able to undertake their own personal care , although may need, on some days, encouragement to do this. The discussion also confirmed that they are supported to access healthcare treatment and attend appointments independently as appropriate. The records viewed in relation to this resident mainly presented the mental health issues and did not fully reflect the residents needs or support required from staff in London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 16 addressing their physical health needs, particularly weight issues and specific dietary needs and the identified hernia problems. The plans should be specific about the interventions and support required by staff and how staff are to be alerted to signs, symptoms and triggers of deteriorating mental health. Within the care plans there were good records relating to healthcare services provided through the multi disciplinary team. The medication systems were inspected. Medications were securely stored in the staff office . Suitable cupboards and a drug trolley were available. At the time of the inspection there was no overstocking evident .All medications checked were in date. There was good information in respect of drugs as well as guidelines on medication administration. Depot medication is administered through the hospital out patient clinics or visiting CPN’s. There were no controlled drugs on site nor have there been since the home opened. Pharmacy advice is provided through the local PCT, six monthly inspection are conducted, reports were available the last one being January 2006,another visit is due. Homely remedies were listed including the reason for administration and the maximum dose ,these were signed by the GP. Both GP’s covering the home confirmed the homely remedies. The inspector was advised that staff are trained on medication issues through Bromley College via a distance learning scheme. Supervised sessions in relation to medication administration, ordering and disposal are conducted in house. In addition there are a number of trained RMN’s who work in the home. Only staff trained in medication administration do so. Medication administration records had resident’s photographs in place and allergies recorded. Those medications, which had been received into the home, were recorded except where hand transcriptions were entered. Those entries, which were hand transcribed, were without two staff signatures. Two staff need to sign hand transcriptions to confirm that the hand written entry is accurate. Currently there are no residents who self medicate. The records for returned medications were in place. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 17 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): The quality rating in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information and advice on how to make a complaint was available. All complaints are taken seriously . Staff interviewed demonstrated a variable knowledge in respect of adult protection and whistle blowing procedures. All staff must be conversant with these procedures and avenues for reporting of such events. EVIDENCE: The home has a procedure for dealing with any complaints or concerns raised, a copy of which is on display in the home. This meets with the Regulations. Discussions with a resident showed that they would not have any problem in raising issues and this is conformed by the complaints register where complaints are recorded. The residents are also able to raised issues during the regular monthly meetings. It is apparent from the complaints register that the majority of complaints are those raised against other residents rather than the quality of care in the home or any issues around their treatment. All complaints are taken seriously with the home recording the complaint and how they are dealing with it. The system could be further improved by ensuring there is a clear outcome recorded and that this outcome has been discussed with the complainant to determine if they are satisfied and therefore the issues resolved. The home may wish to consider another recording system to ensure that they are able to show the investigation over the time period (with enough recording space) before the next complaint is recorded. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 18 The home has policies and procedures in place for the protection of adults including Whistle-blowing for staff. The procedures provide information on types of abuse and what to do if abuse is suspected. It refers to involvement by other agencies but does not make clear who is responsible for co-ordinating any investigations. Nor does it include the local Inter-Agency guidelines. The procedures must also make clear the outcome for staff where allegations have been substantiated i.e. the application for the person to be placed on the Protection of Vulnerable Adults register. The two inspectors met with a number of staff individually. Some staff spoken to demonstrated a variable knowledge and understanding of adult protection and the meaning of whistle-blowing. Some staff interviewed demonstrated a good knowledge of whistle blowing and abuse, more importantly that any incident should be reported. Other staff related only a basic understanding of the procedures to follow. Please see requirement 3.Please see recommendation 2 and 3. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 19 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): The quality rating in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is maintained in a domestic manner with homely fixtures and fittings in communal areas and individual bedrooms. EVIDENCE: The home is situated in a quiet side road off the Bromley Road approximately 15 minutes walk from the shopping centre and civic amenities in Catford. The home has 13 single rooms and one double room. There are two toilets and a bathroom on the ground floor and one bathroom, one shower room and three toilets on the first floor. The home has a large pleasant garden with a patio and seating area. There is a communal area with separate areas for dining and activities including a pool table and TV. There are two smoking rooms, one on the ground floor and one on the first floor. On the day of the inspection the home was satisfactorily maintained and decorated with communal areas comfortably furnished. The home is generally clean and, apart from smoke odours on the first floor, free from offensive odours. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 20 There is a pool table provided for residents and an exercise bike. Resident’s benefit from smoking rooms as no smoking is allowed in private rooms or main communal areas. The home has a separate laundry area. Within this area there is an industrial type washing machine with a sluice cycle and a separate, tumble drier. This area is sited away from food areas. The inspector did however see one resident in her room who was smoking. There was a long discussion about this. In conclusion when residents are known to smoke in their bedrooms despite the house rules staff must ensure the safety of residents and staff. Appropriate risk assessments and procedures must be put in place to minimise the known risk Whilst the kitchen is not domestic in its furnishings it meets residents’ needs in that they are able to use the equipment under staff supervision. A recent Environmental Health visit made a number of requirements that the home is addressing. Individual rooms were personalised with furniture and possessions brought from home. In some cases the rooms are cluttered with residents own items, which could present a fire risk. Residents spoken to were satisfied with their accommodation. This was generally borne out by the results of the recent survey. Residents have their own front door and individual room key. Please see requirement 4 London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 21 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): The quality in this outcome area is adequate .This judgement has been made using available evidence including a visit to this service. Staff are provided in sufficient numbers to meet the residents needs. Staff undergo recruitment procedures prior to employment however some information needs to be more thoroughly checked and evidenced. EVIDENCE: During the day time period the home is staffed by three support workers, together with ancillary staff. At night there are two support workers where one sleeps for half the shift and the other provides waking staff. The roles are then reversed. There are fifteen support workers employed of which ten have NVQ level 2 or above. Within the staff team there are four qualified nurses. Three staff were interviewed as part of the inspection process, two care staff and one domestic/care staff. The staff were asked about recruitment procedures and areas of work. The senior support worker was NVQ 3 trained and was doing NVQ4. She had been in post three years and demonstrated a good knowledge of the service, the residents, and mental health issues generally. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 22 Once she had completed the recruitment process she had received a one week induction. She confirmed that she had received a lot of training on statutory topics and those related to mental health issues. Included in the training was anger management, challenging behaviour, care planning health and safety and manual handling. A second staff member interviewed was a bank staff. He too confirmed induction and some training although specific items relating to mental health had not been addressed, in addition he had not received training in adult abuse. The third staff member was studying a BSc whilst working as a support worker/cleaner in the home. He confirmed that the two roles were separate and he was not expected to do the two jobs during the same shift. He was aware of basic heath and safety principals although did not comprehend terms such as COSHH. The inspector noted from the pre inspection information that four staff shared the same surname . It was confirmed by staff that these staff were related. In such circumstances where relatives work together the interests of the residents must be paramount and relationships whilst on duty, professional. It is recommended that a policy be drawn up to address such matters. The deputy was aware of the possible conflict and difficulties that this may cause and was receptive of the recommendations made. The files of the last three members of staff employed were viewed. There were some discrepancies in the dates of starting with different dates on different records. It is important that this information is accurately recorded. One example in a staff file, showed the person to have commenced on 30/5/06 the CRB had arrived in July 06. Another record showed the same employee to have started on 1/8/06,e.g. the application form was completed on 30/5/06 but the reference was dated 12/5/06. The other reference was a confirmation that the individual was enrolled as a student dated 10/11/05. On another file the application form had not been fully completed but had a CV detailing the information. There was some discrepancy in the information provided particularly around the last employment. The CV gave one address whilst the references another address. There was no evidence to say that this was investigated and explanation sought. All had Criminal Records Bureau checks, proof of identity and some form of reference although this needs clarification. Where appropriate copies of certificates were also obtained Each file contained a copy of the job description and induction checklist. For the most recent employee who had started in August 2006 there has been no Skills Sector foundation training taking place to date. This is quite a delay, especially where there is core and service specific training required and the London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 23 person has not had experience with this resident group previously. In addition the inspector was unable to establish if the Codes of Conduct had been issued. Supervision ,was said by staff to take place. There was good evidence of supervision in one file, but for the new employee there was only one formal supervision. More supervision should have been provided in three months due to this staff members’ relative inexperience. Please see requirements 5 and 6. Please see recommendation 4. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 24 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): The quality rating in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced nurse who is trained in the field of psychiatry. Quality assurance systems are in place however further action in respect of outcomes needs to be evidenced. Health and safety issues are addressed although fire training needs improvement. EVIDENCE: The Registered Manager is also the owner of the home and therefore is involved in the day to day running of the business. The Manager/owner is an experienced Registered Mental Health Nurse. He has managed mental health care homes for many years and has managed the London Mental Health Care Centre since he opened it six years ago. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 25 The system for monitoring and reviewing the quality of care includes regular resident and visitor surveys as well as day-to-day monitoring of the procedures. The last survey was undertaken in the Summer 2006. The results were collated and analysed but as yet no report has been completed on the improvements required as a result of the feedback. The Manager must ensure he is meeting the Regulations in respect of this and in particular to the recent changes to Regulation 24. Please refer to comments under the staffing section regarding staff training and recruitment where requirements have been made. The inspector was told of the regular meetings that are held with residents where they could bring forward any concerns or issues about life in the home. These meetings are recorded although there was little evidence of what the home is doing to act upon those issues raised. At the end of the meeting a named individual should take responsibility to address the areas raised, if appropriate. The home should also consider how it may involve residents more in the running of the home, for example: involvement in the selection of new staff. It was positive to note that the home consults with residents not only through residents’ meetings but also through the use of surveys. In order to determine how the health and safety of residents and staff were being met the inspectors viewed a sample of service contracts and toured the home. Overall there were satisfactory systems in place with equipment used being regularly serviced. The home also ensures that the fire system and equipment is checked and staff and residents are involved in fire drills. The records of fire drills need to be improved to show the timing of the drill and to ensure at least four drills are undertaken each year at night. Fire instruction must also be provided for each member of staff at least annually and there was evidence that this had lapsed. Good practice would state that the home details what is included in the fire instruction to staff. In addition please refer to comments made in the environment section regarding potential fire hazards identified in individual bedrooms. Within the care plan documentation there was information relating to residents accounts, bank book and statements. There was statement of agreement in relation to assistance with financial affairs. Further evidence in respect of auditing and monitoring of staff adherence to policies and procedures is needed to confirm staff’s knowledge in those areas. Please see requirements 7 and 8. Please see recommendation 5. London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 26 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 2 3 X 4 x 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 x 2 2 x London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 27 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. YA2 Standard Regulation 5 Requirement The Registered Manager must ensure that Regulation 5 of the Care Homes Regulation is met in particular in relation to recent changes. The Registered Manager must ensure that care plans and risk assessments are current, comprehensive in content and fully reflective of the needs and risks of the individual. The Registered Manager must ensure all employees, including care and ancillary staff are fully conversant with adult protection and whistle blowing procedures. The Registered Manager must ensure that all areas communal and individual bedrooms are retained hazard free The Registered Manager must ensure that all recruitment checks are undertaken including checks on discrepancies in information and gaps on employment. The Registered Manager must ensure that all staff undergo induction training immediately on commencement of DS0000025631.V317183.R01.S.doc Timescale for action 31/03/07 2. YA6 15 31/03/07 3 YA22 22 31/03/07 4 YA24 5 YA34 23 31/12/06 18 31/12/06 6 YA35 19 31/12/06 London Mental Health Care Centre Version 5.2 Page 28 7 YA39 8 YA42 24 employment, which covers statutory topics and those related to the resident group. The Registered Manager must ensure that the recent changes to Regulation 24 are addressed . The Registered Manager must ensure that all staff and where appropriate residents, are trained in fire procedures including drills 31/03/07 23 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. YA2 Refer to Standard Good Practice Recommendations The Registered Manager should ensure full and comprehensive information is available from those involved with the residents care prior to admission and that the home confirms this information through its own assessment records. The Registered Manager should consider another recording system to ensure that they are able to evidence the investigation trail and period of time this took. The Registered Manager should include in the policies and procedures for adult protection , reference to interagency guidelines The Registered Manager should ensure that staff supervision is conducted six times a year minimum, or more frequent should the employee require it. The Registered Manager should assess and audit staff’s adherence to the homes policies and procedures 2 YA22 3 YA23 4 YA36 5 YA41 London Mental Health Care Centre DS0000025631.V317183.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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