Inspection on 24/04/09 for London Mental Health Care Centre

This inspection was carried out on 24th April 2009.

CQC 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 CQC judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

London Mental Health Care Centre 06/05/08

London Mental Health Care Centre 01/10/07

London Mental Health Care Centre 13/11/06

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 16/02/2010.

Key inspection report CARE HOME ADULTS 18-65 London Mental Health Care Centre 78-80 Arran Road Catford London SE6 2NN Lead Inspector Miss Rosemary Blenkinsopp Unannounced Inspection 24th April 2009 09:45 London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address London Mental Health Care Centre DS0000025631.V375130.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 698 8770 0208 698 8770 Arranhouse@aol.com 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) Dhaneswar Dooraree Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15) of places London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 15 1st May 2008. 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. Staff in the homework in collaboration with the multi disciplinary team to provide a consistent approach to achieving their needs and managing their mental health conditions. The staff team includes a number of RMN’s and staff with NVQ qualifications. The weekly fees are between £700 - £1,300. London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate. The inspection was conducted over a one day period by two inspectors. The Deputy Manager facilitated the inspection. The Registered Manager did not attend for the whole inspection although did attend for part of the morning. Periods of observation were undertaken in the communal areas where residents were located. Prior to the inspection the Manager had completed the AQAA and forwarded this to the CSCI. No comment cards were received prior to the inspection although some were during the site visit. During the site visit the inspector met with several residents and three multi disciplinary team members Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. Documents were inspected during the site visit including care plans, staff personnel files as well as health and safety records. Feedback was provided to the Manager at the end of the inspection. Other information, which was considered when producing this report and rating, consisted of information supplied and obtained throughout the year including Regulation 37 reports and complaints. What the service does well: The home provides a supportive environment where residents who suffer from long term and enduring mental health conditions are given an opportunity to further develop the skills they need for independent living. Within the staff team are a number of Registered Mental Health Nurses who have a significant amount of experience, which is beneficial in this type of setting. Involvement by and regular communication with the multi disciplinary team ensure that residents have a consistent approach to care and that their objectives are jointly agreed. London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. London Mental Health Care Centre DS0000025631.V375130.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.V375130.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre-admissions procedures provide residents with the information they require prior to any decision regarding placement being made, to establish whether the service is right for them. The information provided to staff enables them to set up an initial care plan to meet the needs of the resident. EVIDENCE: On the day of the inspection there were 13 residents on site of which several were on Section117 after care sections. Admission information and assessment reports were retained on file. London Mental Health Centre conduct their own assessment once a referral has been received. A pre admission questionnaire is also completed. Additional information including the previous care plan information and reports from Care Programme Approach reviews. All of the information provided a good picture of the residents and their presenting needs. Staff told us that residents were provided with opportunities to visit the service and stay over night. The London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 9 number of visits may vary depending on the individuals needs. In reality residents have limited choice in where they live, as there are few facilities that provide support for this category of resident. The terms and conditions of residency were on file. The Statement of Purpose and Service User Guide need to be updated to reflect the current staff group, their skills, management structure and the new Regulatory body. London Mental Health Care Centre DS0000025631.V375130.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments are comprehensive in content and detailed enough to ensure individual care needs of people who use the service are met. Residents are consulted on and have choices in their daily lives. EVIDENCE: We randomly selected care plans. Those care plans viewed had photographs of the residents attached which is essential should the resident go missing, as police may require a description and photograph. The care plan included issues around presenting mental health, rehabilitation and physical health needs. The interventions were to a good standard. The staff and residents signature were recorded on some of these care plans. Evidence of regular weight, pulse and London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 11 blood pressure checks were recorded, and where issues were identified, care plans were in place for the problems. Risk assessment tools were in use. Those areas identified as potential risks were incorporated into a risk overview document. In cases where residents had specific risks associated with their behaviour or condition, these were recorded with the information and actions needed to minimise the risk. One resident had specialised equipment in use, which needed very detailed risk assessments because of the potential fire risk – there was some assessment of risks, although more information needed to be included to ensure the risk of fire was lessened. Resident’s daily records, which give an outline of how they spent their day, were to a reasonable standard. Key worker sessions were recorded. Residents said that they were involved in their care plan and invited to reviews. They indicated that they were supported in aspects of daily living. London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 12 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): This is what people staying in this care home experience: 12,13,15,16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has increased the rehabilitation activities both within the home as well as improved use of local amenities such as day centres. Access to the community and local services provides residents with opportunities to engage with the local community and enhance their daily living skills. EVIDENCE: Periods of observation were undertaken during the site visit. Residents were watching TV; one was playing pool others were in the garden. London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 13 Residents told us that they did various activities including visiting their friends and families. They said that they went shopping and generally were free to come and go. It was apparent that residents had some choices in their day, although resident’s wishes cannot always be met as this is sometimes in conflict with the rehabilitation aspects they need. For example one resident wanted to spend the whole day in bed yet this is not in line with active rehabilitation. Some of the resident’s attend day centres and other local facilities. Six residents are involved with day centres whilst one is attending college and another is doing paid work. This is to be commended. One gentleman plays football weekly, which he really enjoys. Residents indicated that they looked after their own bedrooms with staff support and said that they did some cooking. In each care plan there is a weekly activities sheet to detail what the residents took part in. Fresh fruit and biscuits were available in communal areas. The kitchen was inspected. The kitchen was stocked with a selection of fresh, frozen and tinned food. One item of food was past its use by date this was disposed of by staff. The kitchen is kept locked because of the risk posed by one resident. This is restrictive to all those who live in the home and particularly as it is a rehabilitation service. Management need to put in place sufficient safety measures, which do not negatively impact on all those who live in the home but afford sufficient protection to those who need it. Activities such as a pool competition had been organised as requested from a resident. Additional equipment for leisure activities had been purchased including table tennis equipment. London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have their health care needs met by staff in the home supported by members of the multi disciplinary team. Medications are safely managed which means residents have the correct medications given at the correct time. EVIDENCE: Of the 13 residents on site – 8 are under Enhanced Care Programme Approach, which is a system of close monitoring and aftercare for mental health residents. We had an opportunity to meet with three members of the multi disciplinary team who were in the home. Positive feedback was received from all three people. They said that the home takes some of the most challenging residents who have been in mental health services for many years. Staff they felt showed their initiative and sought help appropriately. They said that the London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 15 standard of the reports produced for meetings were always to a high standard, informative clear and comprehensive. They have managed some of those residents who have been in services for many years. One member cited examples where specific training in relation to one resident’s condition had been requested and this had been provided to staff in the home. Staff were said to be never phased. Records relating to visits by the multidisciplinary health input were on file. One staff comment card stated they had seen” great improvement in the clients “. Usually, in this home, the residents are able to address their own personal care although most require some level of prompting and reminding. Some of the residents do have personal care incorporated into their care plans to indicate to staff what support they would require in this area. Residents have their preferences in relation to gender care addressed as the staff team has male and female staff. The medications were inspected including the storage of the actual medications and the supporting records. Medications are stored in the ground floor staff office, which is where residents, attend to take their medication. The medication charts had photographs of individual residents for identity purposes. The individual allergies that residents suffer were recorded. Medications received in to the home as well as those returned to pharmacy were recorded, this provides information when auditing medications to check correct administration procedures. There were good supporting health records for blood sugar monitoring for one resident. There was a list of homely remedies, which indicated the drugs to be used and for what purpose. The list of homely remedies was signed by the GP and dated September 2008. Records for homely remedies medications administered to residents were completed. The “as required “, medication protocol was in place and dated February 2008. Homely remedies had directions for use and charts were well completed. One resident self medicates a heart tablet. He has done so for many years. A risk assessment was in place although his needs to be expanded to ensure that the resident is capable and knows how to take the medication appropriately. It is particularly important when residents have fluctuating mental health issues, which may impair concentration attention, and thought processes, which may affect their ability to self, medicate. London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 16 Lewisham Primary Care Trust (PCT) conducted a monitoring visit September 2008 this is part of regular auditing conducted by the PCT. The medications were found to be satisfactory. The medication policy had been reviewed August 2008. Medication training by the pharmacist had been conducted April 2008. London Mental Health Care Centre DS0000025631.V375130.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are insufficiently protected from potential abuse, as the home’s policies and procedures as well as staff knowledge and training are limited in these areas. EVIDENCE: The procedures relating to complaints and protection were viewed. The complaints procedures were on display although will need updating to reflect the new organisation and address. It is advisable that this also be printed in large print. The adult protection procedure should include referral through the Local Authority for investigation first before the home does its own investigation. Currently it indicates the home will investigate matters first, and then refer them on. The home did not have the local guide issued through Lewisham on Safeguarding Vulnerable Adults.This needs to be obtained . It is particularly important when dealing with residents who suffer from mental illness to have staff who are knowledgeable and receptive to resident’s comments, concerns or complaints. Mental health residents tend not to complain about there surroundings, activities or staff, as they feel they may not be listened to and that action will not be taken, or that their complaint will be put down to their mental illness. London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 18 There was one example witnesssed by us, whereby a staff member demonstrated a limited sensitivity and understanding when a resident was upset and offended by something she saw in a newspaper. Residents who suffer mental health problems may have many issues that cause them distress; staff must be aware of these and deal with them in a sensitive, professional manner. The CQC has had no information regarding complaints about the service. The home retains a complaint record sheet, which is used to record the complaint information. The last entry in this book was 22/04/08. Any form of abuse that a resident may be subject to is outlined in a risk assessment. As part of the site visit staff were interviewed. There was some lack of clarity on whistle blowing issues and reporting these through external agencies. The CRB’s are done through an umbrella organisation. The organisation then confirms that the prospective employee is suitable to work in the home. The Manager must have sight of CRB’s and take the decision on whether the candidate is suitable to be employed. This may mean that the employee’ brings in their own CRB as the umbrella organisation will not send on the CRB to the home we were advised. Within the information included in the AQAA the following statements were made “ Staff to get more training regarding Protection & Safety of service users and premises, and aim towards 100 staff training on Abuse/POVA.” “All service users to be made aware of the complaint procedure and awareness raised during residents meeting/key worker session.” Please see requirement. London Mental Health Care Centre DS0000025631.V375130.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides adequate accommodation and the home needs continual redecoration and maintenance to ensure that residents live in a homely environment. EVIDENCE: The home is located in a residential area of Catford. Parking is available to the front of the building. The residents admitted to this environment must be mobile as there is neither lift facility nor are there any adaptations to aid mobility. A tour of the environment was undertaken, including communal areas and those individual bedrooms where residents would allow us access. Bedrooms were personalised and decorated to meet the individual’s requests. London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 20 Communal areas are domestic in style with TV radios and a pool table. In addition there is a smoking area on the first floor. The dining area is on the ground floor. Carpets in the lounge area were stained and needed cleaning or replacement. One resident wanted more furniture in his bedroom and in the lounge although these were fully furnished. The garden is easily accessible through the patio doors. Garden furniture was available. The garden is laid with lawn and some plants, which residents attend. Toilets and bathrooms are available throughout the home. There were locks on the showers, which could not be accessed from the outside in an emergency, this needs to be corrected. On one door the hole was still not repaired where the lock had been removed. In one bathroom the shower flow was too slow to actually have a proper shower. In one ground floor area there was a sluice sink with a kettle next to it. We were advised that this area was a kitchen/ snack area. If this area is to be used as a snack kitchen then an appropriate sink must be fitted as currently this poses an infection control risk. Parts of the communal areas were in need of redecoration and upgrading paintwork and wallpaper was in parts suffering wear and tear. There was a rodent bait box in the area adjacent to the dining and kitchen facility. Radiators were in some places hot to the touch and reading at 56 degrees these were not covered although staff stated that risk assessments were in place. The home uses metal chains to restrict the windows – whilst these serve the purpose a more domestic type should be considered. The following information was extracted from the AQAA: “As part of our action plan, we have brought about the following changes: redecoration of rooms and communal areas, cleanliness of the home improved. The flooring in Room 2 was changed and a new carpet fitted in smoking area. Painting and redecorating of rooms and communal areas. All service users are currently happy with the homely environment of the place.” Please see requirement. London Mental Health Care Centre DS0000025631.V375130.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are adequate to support residents. Training includes mandatory updates as well as mental health issues, which equips staff with the knowledge they need to under take their work. EVIDENCE: As we arrived the Deputy Manager was on duty with support workers – one was sick and was replaced during the course of the morning. The Deputy Manager and a senior support worker coordinated the inspection. The care staff team are supported by a domestic who is employed 20 hours a week a handyman, and a cook who starts at 4pm daily. We inspected the staff personnel recruitment files to check that staff had been safely recruited. Staff files were historically weak in parts – although as staff had been in post for some time these had been subject to inspection London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 22 previously. Files must comply with all of the requirements as stated in the Care Standards Act 2000 and it’s associated Regulations. Staff had good knowledge of residents needs and felt that they had adequate support provided through the management. In addition they felt able to contact the multidisciplinary team for advice and assistance at any time. They said that they were involved with reviews. Training had been improved upon and staff confirmed that the statutory topics were repeated at regular intervals. In addition specific training sessions had been organised in relation to resident’s conditions. In the AQAA the following was stated:” Most staff have been provided with training in different areas of health and social care. Staff have been on NVQ training as well as various short courses including one-day training, distance learning courses and in-house training”. The home is aiming to have 100 NVQ Level 2 trained staff”. Staff confirmed that supervision took place with one of the management team. Staff meetings are held, the minutes of which were seen. Please refer to previous section Concerns, Complaints and Protection for comments on recruitment. Please see requirement. London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality assurance measures include the views of those in the service, which provides opportunities to input into developments in the service. Health and safety service certificates were up to date, however some of the safety precautions specifically those for fire need to be reviewed to ensure the premises are safe for residents to live in. The management team need to be more proactive to ensure the home is managed in line with current legislation and guidance. EVIDENCE: London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 24 The owner of this facility is also the manager. The home has several layers of management. This can be supportive and provide reassurance to staff and residents although it was difficult for us to establish who was the senior during the key inspection site visit. The levels of management must be clear so that people know who is in charge. A number of service and maintenance certificates were inspected to check that the home is safe for residents to live in. Stickers confirmed PAT testing was current. The gas service had taken place July 08. The employer’s liability insurance certificate was current. Fire safety records were inspected. The fire risk assessment was not viewed on this occasion, but the home is reminded that this must be reviewed regularly particularly if other potential risks are identified. We inspected fire precautions including exits. Fire door guards, which automatically release when the fire alarm, sounds were available in some areas. There were issues identified relating to access to the fire escape exit which is located through the kitchen. The kitchen is locked because of the risk presented by one resident – however the home should effectively manage the risk without it negatively impacting on the other residents. In addition the patio door, which is also a fire exit, should have the locking mechanism reviewed. It is recommended that the fire officer be contacted to visit in respect of these issues. Fire safety is particularly important in homes where there a number of residents who smoke some of whom have a lack of insight. Records indicated weekly fire alarm testing and these had taken place a various times of the day. Emergency light tests were recorded weekly. The fire risk assessment and emergency plan were available although not inspected at this visit. Fire equipment had been serviced April 2009. Following the inspection there was an e-mail received stating those items identified at the site visit, particularly fire escapes and exits, had been addressed. The fire book had a list of fire drills with those staff and residents attending listed. Staff need to sign for all training to evidence that they have attended the sessions. The first aid box in the kitchen was without blue plasters, which are needed for use where food is handled. One staff comment card included the following” the care home is professional and well organised”. Quality assurance had significantly improved and there was evidence of results from resident’s staff and visitor’s questionnaires, these were seeking their views on the service. In addition there was a survey sent to the multi disciplinary team, and the results indicated that a good service was provided. London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 25 Each resident in this service has a bank account. There is also a book retained on site, which is a record of resident’s expenditure. Receipts for expenditure are retained only if residents produce them. Please see requirement. London Mental Health Care Centre DS0000025631.V375130.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 3 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X 3 3 X 3 X X 2 X Version 5.2 Page 27 London Mental Health Care Centre DS0000025631.V375130.R01.S.doc 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 YA23 Regulation 13 Requirement Staff must have sufficient knowledge on abuse and protection to ensure that residents are protected from harm. The hot water and radiator temperatures must be maintained at safe temperatures for residents to use. All staff working in the home must be safely recruited including checking of CRBs, to ensure residents are in safe hands. The premises must be safe for residents to live in and have adequate fire precautions including accessible fire escapes and meet all current fire regulations. All potential risks must be identified as part of the fire risk assessment. Timescale for action 30/06/09 2 YA24 23 30/06/09 3 YA34 19 30/05/09 4. YA42 23 30/05/09 London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA41 Good Practice Recommendations The Registered Manager should assess and audit staff’s adherence to the homes policies and procedures. London Mental Health Care Centre DS0000025631.V375130.R01.S.doc Version 5.2 Page 29 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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