Inspection on 06/05/08 for London Mental Health Care Centre

This inspection was carried out on 6th May 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 9 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 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 28/09/2008.

CARE HOME ADULTS 18-65 London Mental Health Care Centre 78-80 Arran Road Catford London SE6 2NN Lead Inspector Miss Rosemary Blenkinsopp Key Unannounced Inspection 1st and 6th May 2008 08:40 London Mental Health Care Centre DS0000025631.V362904.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.V362904.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.V362904.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.V362904.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 October 2007 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.V362904.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 and a half day period. The newly appointed Acting Manager facilitated the inspection. The Registered Manager did not attend for the inspection. 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. Three comment cards were received including two from staff and one from a resident. During the site visit the inspector met with several residents and one Community Psychiatric Nurse who was visiting the home. 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. Selections of 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: What has improved since the last inspection? London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 6 The medications systems had improved in some areas and it was apparent that the advice provided at the last site visit and by the Pharmacy inspector had been actioned The home is addressing with all employees adult protection and whistle blowing procedures, knowledge of which was evidenced at the site visit The home has appointed an Acting Manager who if appointed to the permanent position, would have a greater management input than is current Records of staff supervision were in place in those files selected. 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.V362904.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.V362904.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): 2 and 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The pre-admissions procedures generally provide residents with the information they require prior to any decision regarding placement being made, to establish whether the service is right for them. Generally the information provided to staff is incomplete and provides limited information on the needs of the resident. Without comprehensive information on the resident’s needs, staff will be unable to confidently assess if the can meet their needs. Good assessment information is also a foundation on which to base an initial care plan. EVIDENCE: At the time of the inspection there were 13 residents on site. A new admission was expected later that day. In the last three months the home has admitted one new resident. This care plans and assessment information was included as part of case tracking. The resident’ had been admitted on Section 117 leave. Section 117 is a mental heath section which details the after care arrangements which should be in place for that individual resident. Those residents who are under Section 117 will also be subject to Care Programme Approach. The official form for this process was complete however except for an incorrect address. As this is a London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 9 legal document checks should be made to ensure the accuracy of the information both by the author and the receiving facility. The assessment information included a photograph of the resident. This is important should the resident go missing police would need a description and a photograph to assist them with their enquiries. The pre admission questionnaire indicated a number of areas, which would be considered risks including a history of arson, suicide alcohol abuse as well as a forensic history. The only information on this form was a box ticked “yes”. On the form the signature of the person completing it and their designation were omitted. Other information, which was not completed, included the “current mental health needs “section and the “reasons for high support “section. It is essential that prior to any admission all information is obtained and staff have a chance to assess it. This information must be considered not only in light of the presenting admission but the current client group as this may increase dependency and influence staffing arrangements. The referring hospital had supplied a discharge summary, which contained good information. Additional information included a report from the psychologist, which again referred to “a moderate risk of future violent offending”. Care Programme Approach (CPA) information included a summary about the resident. One newly admitted resident met with the inspector and confirmed that they had spent time in the home prior to permanent placement. However they were unable to confirm if they had received any further information regarding the service including the Statement of Purpose. In both files contained a list of “house rules” and terms and conditions of residency. There was Service User Guide on site, which clearly indicates that the service is to provide rehabilitation for residents. In the second file selected for case tracking there was an admission profile with the diagnosis included. The “activities of daily living functional assessment”, was also completed. Other documents relating to pre admission information provided and obtained, could not be located. There was no reference to trail visit or an indication of other information provided to the resident prior to admission. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 10 It is essential with all residents, but particularly those with complex mental health issues that residents have an opportunity to sample the service. This serves two purposes, one staff to meet the resident and secondly residents to engage with one another. All information pertaining to the resident needs to be obtained prior to admission to enhance staff’s knowledge of the potential needs and risks the resident may have. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 11 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): 6,7,and 9.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are insufficiently comprehensive in content to ensure that the specific interventions including those to reduce risk, are detailed enough to ensure individual care needs of people who use the service are met. EVIDENCE: The first care plan had issues covering mental health medication and one physical health problem recorded. The staff and residents signature were omitted on some of these care plans. Without a signature, confirmation of the resident’s involvement in drawing up the care plan cannot be evidenced. Those areas identified as potential risks were incorporated into a risk over view document. This contained only brief information with limited interventions to address the problems that the identified risk would cause. Additional individual risk assessments were in place for some areas, again these were limited in the London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 12 identified actions to minimise the risk. Staff need to be provided with specific instructions to ensure that the risk is safely managed and where possible eradicated. A member of the multi disciplinary team referred to the lack of comprehensive information contained in the care plans as an issue. In addition there was some concern expressed as to whether the actual content was implemented. In the second care plan there was an overview of the resident’s mental health assessment. An activities of daily living assessment was in a tick box format with no additional comments. This provided only limited information to staff on what areas of rehabilitation and level of intervention the resident would need. The care plan outlined physical and mental health issues as well as those relating to rehabilitation. The staff member and the resident’s signature were in place as confirmation of her input into the care plan. An activities sheet had entries such as “went clubbing”,” Out and about“. There was little reference to what if any rehabilitative activities had taken place. The weight chart had entries in both kilos and imperial measures. Since the beginning of the year the charts entries have been recorded in kilos however before that the entries were in stones and pounds. This could cause confusion, as you cannot immediately see changes in weight. CPA reviews were retained in the files indicating the action to take and progress made in respect of identified problems. Information received referred to the fact that issues arising out of CPA meetings would often not be actioned by the home. The daily events were in parts to a reasonable content although statements like “had a pleasant day “said little about the resident’s health including their presenting mental state. London Mental Health Care Centre DS0000025631.V362904.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): 12, 13, 15,16,and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally opportunities for rehabilitation are available within the home although some restrictions may prevent these being maximised to the resident’s full potential. Access to the community and local services provides residents with opportunities to engage with the local community and enhance their daily living skills. EVIDENCE: The home accommodates male and female residents up to around 65 years. This home sets out in its Statement of Purpose that the aim for residents is to move on to more independent accommodation and this will be achieved through rehabilitation input. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 14 During the two site visits there was little in the way of active rehabilitation going one. One resident was playing pool with a staff member and one resident was seen to put his washing in. The TV and the radio were playing throughout both of the site visit. Two daily newspapers were also available. The fact that the TV was always on with the radio in close proximity was said to give one resident a headache. It is accepted that residents enjoy watching the TV or listening to the radio however some limitations may be beneficial especially to focus residents on rehabilitation activities. Residents in this home do not have free access to the main kitchen hence snacks have to be requested. There are two araes for tea /coffee making facilities in the home. The reason for the restricted access to the kitchen was in terms of safety. Staff will provide for residents when they request although this discourages residents to be involved. The residents in this home do not have front door key only a bedroom door key. Again as this home’s purpose is promotion of independent living skill this should be reviewed and an individual risk assessment conducted on each resident with regards to their suitability. Visiting in the home is open within reasonable hours One comment received regarding the food was that in the evening only cocoa was offered never tea. Information received from the Manager stated that this was an individual case for this resident only, due to the need to reduce the caffeine to promote sleep. He confirmed that all nighttime drinks were available. Staff’s knowledge of rehabilitation was variable some demonstrating a good level others limited. Staff should understand what the purpose of the home is and how that is translated into meeting resident’s aims and objectives. It was noted that the lunch consisted of a selection of sandwiches, which were prepared by the staff. Residents were not involved in this process either in the choice of filling or in the preparation of them. The cook is employed from 4pm where a hot menu is prepared. A bowl of fruit and a plate of biscuits were available in the dining area. The fridge freezer temperatures were identical through out the month of April. Variations do occur in temperatures and the accuracy of these records should be checked and thereafter accurately recorded. There were records in place for food deliveries although no entries since 24/3/08. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 15 The environmental health had visited January 2008 and a four star rating was awarded. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 16 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): 18, 19,and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident can be assured that their preferences in relation to gender care will be addressed. Medications are safely stored, however some of the practices around medications introduce an element of risk, which could pose residents a potential danger. EVIDENCE: Within the home there is mix of male and female staff that can provide personal care and address gender care preferences. Currently there are no residents who require actual assistance with personal care although most require some level of prompting and reminding. Some of the resident do have personal care incorporated into their care plans to indicate to staff what support they would require in this area. All residents are mobile and no specific equipment is required for bathing or in terms of mobility aids. There is no lift within this home so it would be unsuitable for any one with mobility impairment. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 17 The medications were inspected including the storage of the actual medications and the supporting records. These are all located in the ground floor staff office, which is where resident, attend to take their medication. The actual file holding the medication charts was untidy and could introduce an element of risk because of the disorderly manner in which they are retained. The medication policy was also untidy with amendments made onto it and some information not clearly visible. On the medication charts themselves photographs of individual residents for identity purposes were retained. The individual allergies that resident 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 was a list of homely remedies, which indicated the drugs to be used for such purposes and the reason for such. The list of homely remedies was signed by the GP and dated September 2006. The “as required “, medication protocol was in place and dated February 2008. Those medications which are to be prescribed “ as required “ need to have full instructions recorded including maximum dose, reason for administering the medication and where applicable duration before referral to the GP. Lewisham Primary Care Trust (PCT) conducted a monitoring visit January 2008 this is part of regular auditing conducted by the PCT There was a general risk assessment in respect of medications although not specific risk assessments for individuals who wish to self medicate this needs to be developed. Those medications, which are provided to resident, who are going on leave are done so by way of secondary dispensing. Medication is taken from the individual’s own stock and re-dispensed in to a weekend bottle then given to the resident. This practice must be reviewed and specific on leave medications prepared by the pharmacist. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 18 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): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from potential abuse by the home’s policies and procedures as well as staff knowledge and training. EVIDENCE: The information on how to make a complaint was on display and there was a supporting policy on this. This information is also available in several of the home’s other documents including the Statement of purpose. The home retains a complaint record sheet, which is used to record the complaint information. Since November 2007, three complaints had been recorded, one of which referred to the hot water. The three entries were adequate in content. Comprehensive investigation records need to be retained and whether the complainant is satisfied with the outcome clearly recorded. The staff that were interviewed demonstrated an adequate knowledge of adult protection procedures and knew of the importance of reporting such matters. This affords a level of protection to residents who can be assured that such matters will be reported on. Generally staff stated that they had received training in relation to adult abuse although some stated it “some time ago The staff who were interviewed also were aware of what constitutes whistle blowing and how this relates to the work place London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 19 Control and restraint is not undertaken in this home .In an untoward event the police would be called. No staff in this home has had control and restraint training. The home should ensure that all policies clearly state its position i.e. no physical intervention to be carried out. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 20 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): 24 and 30.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is in generally need of redecoration and maintenance to ensure those residents live in a homely environment. EVIDENCE: The environment was in part worn and in need of redecoration and repairs. Walls and paintwork were marked. The lounge carpet was stained. The deterioration in the décor was evident since the last inspection. In communal areas as well as bedrooms redecoration and deep cleaning were required to maintain the home to an adequate standard. This was one area, which the Acting Manager was addressing. In bedroom 6 the walls were marked and chipped this was the case in other bedrooms, which were inspected. The hot water was once again running cold this had been apparent at the previous site visit. Again as at the previous site visit the maintenance man was addressing the plumbing and the hot water system. The lack of hot water provision and temperature in the home was referred to during discussions with residents. Residents must be provided with fully functional facilities to enable London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 21 them to live comfortably within the home and be able to meet their needs. On several occasions we were asked to test the water as it was now running hot although on testing this it was not the case. There is an existing call bell system in the home although this is not a functioning system. In the event of an emergency should occur and with the lay out of the building staff need to be able to summon assistance quickly. It is recommended that some form of personal alarm be issued to provide protection to residents and staff. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment procedures afford resident with protection knowing checks are undertaken prior to employment. Staffing levels are adequate although they do not always allow for the provision of external activities, which should be included in rehabilitation. The training records do not accurately reflect what training staff has received or whether the mandatory updates are addressed. Specific training in mental heath issues was limited which means staff are not fully competent in the conditions residents suffer who live in the home. EVIDENCE: At the time of the site visit there were three staff on duty, which consisted of two support workers and the new Acting Manager Mr Nunkoo. Mr Nunkoo was at this time part of the staffing numbers and not supernumerary. This, he explained, was until a decision was made regarding whether the post would be permanent. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 23 The care staff team are supported by a domestic who is employed 20 hours a week a handyman, and a cook who starts at 4 pm every day. The off duty indicated that there was three staff during the daytime period. In the event that an escort or community outing was to take place this would limit the staffing numbers on site to provide support and rehabilitation tasks. Staff members, who do the late duty, then continue to work the night duty. An unusual arrangement operates in the home where staff works a half waking and a half sleeping night duty. There is a full time night staff that covers five nights. This provides consistency in the night care staffing arrangements. Staff were interviewed as part of the inspection. They confirmed that they were subject to recruitment procedures prior to employment. Those staff that had been interviewed had their personnel files selected for inspection. One of the latest employees was amongst them. She had been in post approximately six months and had had no previous experience in health care having worked in a bakers previously. There was an application form completed which indicate one employment only for a period of two months. Evidence of identity checks were retained. There was a CRB from a previous employment, which although we were advised it was the same owner as this home is not transferable. The self-declaration health questionnaire was in the file. Terms and conditions and a job description were on file. The induction sheet indicated it had been started one month after the commencement of employment and it had taken three months to complete. Supervision records were dated January and March 2008.These indicated that a limited amount of topics were discussed at the supervision sessions A second personnel file had been previously inspected. The personal file of the permanent night staff was also inspected. The application form had work history. The application form was untidy with tippex used on it. Copies of identity checks two references and a CRB were all evident. The CRB was dated 2004 and it is recommended that they be revisited every three years. Induction and supervision records were retained. Those staff who were interviewed during two site visits were asked about subjects pertaining to the residents in this home namely mental health conditions after care procedures and rehabilitation. Their knowledge was variable. It was evident that some topics need to be revisited with staff to ensure that they are competent to undertake their role. Topics such as the Mental Capacity Act and the Mental Health Act all directly impact on the work that staff do and these topics should be considered for inclusion in training. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 24 There was an overview of training although this was mainly relating to training which was available which not that staff had received. The home needs to retain a training matrix for al staff to ensure that there is a clear record of staff’s attendance at training sessions and regular updates in the mandatory topics. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has insufficient management hours to ensure that the acting manager can effectively manage the service, support the staff and promote a quality care. Quality assurance measures are limited and do not fully reflect the views of those in the service. Health and safety service certificates were up to date to ensuring the premises are safe. Staff need to be trained and updated in the mandatory topics to effectively perform the work and met the residents’ needs. EVIDENCE: Mr Nunkoo was the person in charge at the time of the site visit. He has been appointed with a view to taking up the permanent Manager’s position, which is currently held by Mr Raj Doraree. He has previously managed a community London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 26 mental health facility in Leytonstone. He had commenced employment 17/3/08 in this home. He was not employed in a supernumerary capacity, which does not ensure that the home has a strong leadership with maximum management input. The Manager should be able to direct the provision of care provided and ensure that the management of resident record keeping, health and safety and all other items are effectively addressed. The Manager was not present in the home on the day of the visit and it was evident there was a lack of management presence in the home. This we have highlighted on previous visits. Mr Dooraree confirmed that he was supernumerary to the existing staffing levels. A number of service and maintenance certificates were inspected. Stickers confirmed PAT testing was current. The gas service had taken place July 07. Those precautions undertaken in relation to fire prevention were inspected. This 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 as well as tests on emergency lights. The fire risk assessment and emergency plan were available. Fire equipment had been services March 2008. The fire book had a list of staff but no signatures in place. Staff need to sign for all training to evidence that they have attended the sessions. Fire drills for all staff must be annually updated with a recommended four for night staff and two for day staff. Ten staff have attended first aid courses, which means minor accidents, and injuries can be dealt with by staff on the premises. The financial records for resident are recorded in a book. The transactions were recorded although there were very few supporting receipts. This is because the majority of residents deal with their own money purchasing their own items. The book did show that some resident’s owed large amounts to the home. This does not promote good budgeting skills, which would allow people to live independently in the community living within a limited budget. This system should be reviewed. There were limited records relating to quality assurance measures except those for staff meetings. The home needs to develop a quality system to ensure that the views of residents, relative’s staff and visitors are all incorporated to the future development of the service. London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 27 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 3 5 X 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X 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 2 13 3 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 X London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 28 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 YA3 Standard Regulation 14 Requirement Timescale for action 30/07/08 2. YA6 15 The Registered Manager must ensure that all assessment information is obtained prior to placement and that staff are sufficiently briefed on this to establish if the resident’s needs can be met by the home. The Registered Manager must 31/07/08 ensure that care plans are fully reflective of needs, individual to the resident with supporting risk assessments This is now outstanding previous time frame for action 31/03/08 The Registered Manager must 31/07/08 ensure that active and appropriate rehabilitation is facilitated for all residents. The Registered Manager must 30/06/08 ensure that medications are not subject to secondary dispensing All medications need to have full instructions. The Registered Manager must ensure that all areas communal and individual bedrooms are maintained to an adequate DS0000025631.V362904.R01.S.doc 3 YA12 4. YA20 12 13 5 YA24 23 30/06/08 London Mental Health Care Centre Version 5.2 Page 29 6 YA24 23 7. YA35 18 standard of cleanliness and décor. The Registered Manager must ensure that al facilities including the provision of hot water are fully functional to meet residents needs The Registered Manager must ensure that staff are provided with training which equips them with the skills to do the work they do 30/06/08 30/09/08 8 YA39 24 9. YA42 23 The Registered Manager need to 30/09/08 develop a quality assurance system, which includes the views of all parties, involved with and who live in the home. The Registered Manager must 31/07/08 ensure that all staff are trained and updated at regular intervals on the mandatory topics relating to health and safety. 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 YA22 Good Practice Recommendations 1. 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 assess and audit staff’s adherence to the homes policies and procedures 2 YA41 London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. Extracts may not be used or reproduced without the express permission of CSCI London Mental Health Care Centre DS0000025631.V362904.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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