CARE HOME ADULTS 18-65
London Mental Health Care Centre 78 - 80 Arran Road Catford London SE6 2NN Lead Inspector
Kate Matson Unannounced 9 June 2005, 09:15am
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service London Mental Health Care Centre Address 78-80 Arran Road, Catford, London, SE6 2NN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 86988770 020 86977225 Mr Dhaneswar Dooraree Mr Dhaneswar Dooraree CRH Care Home PC Care Home Only 15 Category(ies) of LD Learning Disability registration, with number MD Mental Disorder of places PD Physical Disability London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: This home is registered for 15 persons with a mental health problem, four of whom may also have a learning disability and one of whom may also have a physical disability Date of last inspection 6th October 2004 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 service users. The home has a well-qualified staff team and service users have effective rehabilitative care programmes to enable them to move on to more independent living situations where possible. London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over seven hours. The inspection included speaking with eight service users, the registered provider, acting manager and other staff and examining care plans, staff records and other records. What the service does well: What has improved since the last inspection? What they could do better:
Service users care plans are comprehensive, however progress needs to be recorded on a daily basis to fully evidence how service users are being supported to reach their goals.
London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 6 Service users are supported to maintain appropriate relationships though it was noted that the service users’ phone was located in a corridor. The manager needs to take action to ensure that service users are able to hold telephone conversations in private. Also service users were unclear about a rule about visitors. The manager needs to clarify this to ensure that service users do not feel they are being unnecessarily restricted. The home’s recruitment practices had improved since the previous inspection, though one staff file did not have a disclosure from the Criminal Record’s Bureau at the appropriate level, which potentially places service users at risk of abuse. The homes staff are well trained and progress had been made towards ensuring that foundation training meets the specifications of Sector Skills Council workforce training targets, though induction training needs to be further developed to fully ensure that staff are able to meet service users needs. 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. London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 5 Service users’ needs are assessed prior to admission to ensure that the home is able to meet them. Each service user has a contract or statement of terms and conditions, which ensures that their rights are protected. EVIDENCE: All five of the service user files examined contained comprehensive referrals and evidence of assessment prior to admission. All but one of the service users had a detailed care plan drawn up following assessment. The fifth service user had a brief care plan as he had only recently been admitted and the care plan was still being developed. All of the service users’ files examined included a contract or statement of terms or conditions specifying all of the elements stated in the National Minimum Standards. The contract had been reviewed as required by the previous inspection. This ensures that service users’ rights are protected. London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Although service users’ needs are reflected in their care plan, the lack of daily recording does not fully evidence how the service users are being supported to reach their goals. Service users make their own decisions as far as possible. Service users’ risk behaviours are fully assessed to ensure that risks taken are managed within safe boundaries. EVIDENCE: All service users had a comprehensive care plan in place apart from one service user who had a brief one that was still being developed as he had only recently moved in. The care plans covered all of the areas required in the National Minimum Standards. Activities the service user had taken part in and day-to-day progress were also recorded, where applicable, but neither of these was recorded on a daily basis. This does not evidence how, on a daily basis, the home is meeting service users needs or working with them to achieve their goals. Service users are supported to be independent in as many areas of their lives as possible. Five service users are completely independent in managing their own finances and where appropriate service users are supported towards selfmedication, although none of the current group manages their own medication. On the day of the inspection service users were seen to make their own decisions with regard to what they wanted to eat, what activities they wished
London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 10 to take part in and service users came and went from the home throughout the day. All service user files examined contained a brief risk assessment and fuller risk assessments provided by the service user’s mental health teams. Where risks have been identified these are addressed in the service user’s care plan and are regularly reviewed. London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 16 and 17 Service users are supported to take part in appropriate occupation and activities at home and in the local community. Their rights and responsibilities are respected, though the current location of the service users’ phone does not allow them to conduct private telephone conversations and some service users were not clear about a rule about visitors, leading them to feel that they were unnecessarily restricted. Service users were mainly very positive about the diet offered at the home. EVIDENCE: Service users are encouraged to take part in meaningful occupation, education and training. Two service users are currently exploring opportunities for part time work and one is planning on starting a college course. Three of the group attend drop in centres outside of the home and another two are due to start. Service users confirmed that they played as much of a part in the community as they wished. Some chose to go out little, others visit shops, cafes, library and pubs, independently and with staff support. There is a range of leisure activities on offer at the home. These include, books, television, videos, puzzles and board games. The home also has an exercise bike and a pool table, which was in use on the day of the inspection.
London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 12 Service users confirmed that there are day trips out and barbeques in the summer. Following consultation with service users, who felt that seven day holidays were too long, several short breaks are now being offered throughout the year to ensure that the option of seven days holiday is given to service users as required by National Minimum Standards. Service users confirmed that they were able to have visitors but several commented that they were not allowed in their rooms. When this was discussed with the manager, he stated that visitors are allowed in service users rooms provided visits are pre arranged. This is because there have been problems in the past with some service users having several visitors in their rooms, creating noise late at night and compromising the peace of all the service users. However, service users did not appear to have this knowledge. The manager needs to ensure that this information is made clear so that service users do not feel they are being unnecessarily restricted. It was also noted that the service user telephone is situated in the communal area, preventing them from holding telephone conversations in private. As already stated service users are supported to be as independent in making choices as possible. Rules on smoking, alcohol and drugs are stated in the service user guide. Mail is given to service users unopened. Service users confirmed that staff enter their bedrooms only with their permission. All service users have keys to their rooms apart from one whose lock did not work and this was being addressed at the time of the inspection. Service users were generally very positive about the food at the home. All confirmed that two choices are always available. One service user said, “the food is decent; good quality, plenty of it.” Another said that he felt his diet met his cultural needs. He said, “I get curry and rice at least twice a week and if I don’t like what is on offer on other days, they give me something else.” London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Service users confirmed that they receive the personal support that they need. Service users physical and mental healthcare needs are met and medication policies and procedures are safe. EVIDENCE: Most service users require minimal assistance with personal care, though some require prompting or assistance getting into or out of the bath. There is a key worker system in operation to ensure consistency and continuity of care. Service users meet formally with their keyworker at least monthly but service users confirmed that they are able to speak to any staff member and that staff give them the support that they need. One said, “They help you as much as they can”, and another said, “The staff do the best they can”. The mental health and physical healthcare needs of service users are addressed and monitored. All service users see members of their mental health team regularly. Service user files included evidence of weekly blood pressure monitoring for four service users and appointments for blood tests, dentists, chiropodists and optician. One service user said, “Staff help me make appointments to see the doctor when I need to.” The medication stock and records were examined and were found to be in order. Staff administering medication are either trained nurses or have undergone appropriate training. None of the current service users is at a stage in their rehabilitation where self-medicating is appropriate though most would be able to self medicate before moving on from the home.
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The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Neither of these standards was inspected at this inspection, however both were inspected at the previous inspection and were considered met. EVIDENCE: London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were inspected at this inspection however all were inspected during the previous inspection year and were considered met. EVIDENCE: London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 and 35 The home’s recruitment practices had improved since the previous inspection, though one aspect of practice potentially places service users at risk of abuse. The staff are well trained though induction training does not fully ensure that staff are able to meet service users needs. EVIDENCE: Five staff files were examined and each had two written references in place as required by a previous inspection. All files examined also had a disclosure from the criminal records bureau (CRB) as required by a previous inspection, though it was noted that one of these was only a “standard” rather than an “enhanced” disclosure. It was noted that this was a member of staff who had worked at the home for some time, however the absence of a CRB at the appropriate level potentially places service users at risk of abuse. Training records were available in each staff file. The home has a well-trained staff team with four qualified nurses excluding the manager and seven staff with NVQ level 2 or 3 in care. The manager stated that it is intended for all staff to be qualified. Progress had also been made towards ensuring that the homes induction and foundation training meets the sector skills council workforce training targets as required by a previous inspection. A new staff member had undergone a basic induction that did not meet sector skills workforce training targets, however foundation training workbooks had been purchased, and one of these was being completed by a staff member in the first six months of their employment.
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The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The health, safety and welfare of service users are promoted and protected. EVIDENCE: Records indicated that all fire, gas and electrical systems and equipment in the home are serviced and inspected appropriately and that all internal checks are conducted at appropriate intervals. Environmental health and fire inspections had also been conducted in the recent past and no concerns were identified. Staff have training around health and safety topics including first aid and food hygiene. A risk assessment showing that water temperature regulation was not necessary for service users had been completed as required by the previous inspection. London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 3 Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 3 2 3 3 Standard No 31 32 33 34 35 36 Score x x x 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
London Mental Health Care Centre Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 19 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. Standard 6 Regulation 12 (1) (a) Requirement The registered manager must ensure that service users progress is recorded on a daily basis. The registered manager must ensure that service users are clear about any rules and restrictions in the home and in particular about visitors. The registered manager must ensure that service users are able to make and receive telephone conversations in private The registered manager must ensure that all staff have a CRB disclosure at the appropriate level The registered manager must ensure that the homes induction and foundation training meets skills for care (formerly TOPSS) specifications. Previous timescale of 31/01/05 not met, though progress made. Timescale for action 30/09/05 2. 15 16 (2) (m) 30/09/05 3. 15 16 (2) (b) 30/09/05 4. 34 17 and 19 30/09/05 5. 35 18 (1) (c) (i) 30/09/05 London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 20 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 Good Practice Recommendations London Mental Health Care Centre G52-G02 S25631 LMHCC V232710 090605 stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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