Care Home: Lexham House

What the care home does well Lexham House provides person centred support and therapy to people with severe mental health problems, including psychosis. Service users, some of whom have spent many years in hospital, receive good support to move on to more independent accommodation. Staff take steps to ensure that all interractions with service users are positive and therapeutic both in formal meetings and in the daily life of the house. The Manager has established a culture of responding to service users` assessed needs and of introducing a more flexible programme. In addition she has taken steps to create a much more attractive environment for service users. Staff work with social and health care colleagues to ensure a multi professional approach and to give service users good access to care and treatment. CHT gives a high priority to the professional development of its staff, including providing a 3 year accredited training programme, on which all new staff are enrolled. Recording is of a good standard. Senior staff, in particular the Deputy Director, provide good management support. What has improved since the last inspection? The Manager has continued to review the programme to ensure that it meets the needs of current service users. As a result, additional practical sessions have been introduced and plans are in hand to replace the `flat` programme with alternative ways of promoting more independent living. Closer working with the local Drug and Alcohol Team has been established, with a number of service users attending sessions held at the house. The introduction of more `informal` sessions with key workers, including visits and trips out, introduced last year has continued. Improvements to the building have been undertaken, with new carpeting, some redecoration and new furniture. Further changes in the handling and storage of medication have been introduced, with a CD cupboard, medication fridge and revised procedures. Prompt action has been taken following incidents, including medication incidents. What the care home could do better: Staff turnover has been high, with 6 staff leaving in the past 12 months. The reasons for the particularly high number of staff leaving are unclear, although the shortage of experienced staff, number of sleep-ins and incidence of challenging behaviours are likely to have contributed. The staff team of 8 has been reduced, as a result of the post of a member of staff on long term sick leave not being covered. Staff commented on the impact on service users of having insufficient staff, including a reduction in time spent engaging with people who are feeling distressed and the disruption to relationships caused by staff leaving after a relatively short period. The Deputy Director undertook to review the decision not to cover the post of the person on long-term sick leave, as the project is full with 11 service service users, a number of whom need staff to be be more available. Key inspection report Care homes for adults (18-65 years) Name: Address: Lexham House 28 St Charles Square North Kensington London W10 6EE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sheila Lycholit     Date: 2 9 0 6 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 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 Homes for Adults (18-65 years) 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. 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 Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Lexham House 28 St Charles Square North Kensington London W10 6EE 02089698745 02086968745 chtlexham-uk@yahoo.co.uk www.cht.org.uk Community Housing and Therapy care home 11 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 11 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 categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Lexham House provides support and accommodation for 11 people with mental health needs, including psychosis. The service is provided by Community Housing and Therapy, which runs 6 projects for people with mental health needs. The home is run as a therapeutic community, which aims to support service users to move on to live independently or in supported housing. There are 9 single rooms and 1 double. The building is a 4-storey Victorian house in North Kensington, which is close to shops, public transport and other services. It is unsuitable for wheelchair use, as there are steep steps to all floors. There is single staffing from 9PM until 9AM. Service users therefore need to be relatively self-managing. Fees are currently £925 per week for Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 11 Brief description of the care home new service users. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection took place on Monday June 29th from 10.15am until 5pm. The project was full with 11 service users. One person was in hospital, visiting the service daily and one person had stayed away overnight but returned during the morning. The Manager, Deputy Manager and Senior Therapist were on duty with a Social Work student who was coming to the end of her placement. The Manager and Deputy Manager were en route to a meeting at CHTs office in Fulham but returned straightaway to be available for the inspection. The Deputy Director came to the project to discuss issues, including future developments and staffing levels during the visit. Discussion took place with the Manager, Deputy Manager and Senior Therapist and with service users who were around the house. At least 4 service users returned questionnaires to CQC but unfortunately because of office closures these were not available to inform the inspection report. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: 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. Care Homes for Adults (18-65 years) Page 7 of 29 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the service is regularly reviewed and updated. A sound assessment and admission process has been established, which has recently been reviewed to improve the collection of information regarding the prospective service user. Evidence: The statement of purpose and service users guide is displayed on the notice board in the entrance hall. Additional information about the project and about CHT is available in leaflets and brochures. The files of four service users were seen during the inspection, including someone who is in the process of being re-introduced to the project. Files show that a sound admission process is followed, including a thorough assessment procedure. The Deputy Director of CHT confirmed that the organisation has recently updated its admission procedure to ensure that more comprehensive information, including information relating to risk management, is available. The care plan for a service user who was in transition from hospital was seen on file, which showed that the key worker was working closely with the service user and the care management team to facilitate a successful and safe move back to the community. All Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: prospective service users visit Lexham House on a number of occasions, meeting with other service users and with staff. Feedback from service users regarding their views on the suitability of prospective residents is discussed at community meetings. Each of the four files seen contained a copy of a contract, confidentiality agreement and complaints procedure, with confirmation by the service users that they had received copies, which had been discussed with them by their key worker. CHT continues to be in discussion with the local Mental Health Trust regarding a protocol for admission of out of Borough service users. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this 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 planning is of a high standard. In line with Lexham Houses ethos, service users participate in all aspects of the life of the project. Risk assessments are comprehensive. The format of recording risk assessments has been reviewed to include additional information relating to risk management. Evidence: Copies of an agreed care plan/therapeutic curriculum were seen on each of the four service users files looked at. Each plan was detailed and showed the involvement of the service user. Plans were up to date and had been revised following placement, CPA or internal reviews. Service users always attend and normally chair their reviews, which take place at least every 6 months and more frequently for new service users or where there are concerns. In line with the therapeutic community model which underpins Lexham Houses approach, service users are supported to take part in all aspects of the life of the home. Service user involvement includes regular community meetings, taking part in Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: catering and other domestic activities and representation at staff business meetings. The format of risk assessments has been revised to include further information about previous incidents or past events, so that risk management is based on more comprehensive information. Risk assessments, which are reviewed monthly, are discussed with service users who sign to confirm that the assessment has been discussed with them. It was noted that one service user had refused to sign her risk assessment. Confidentiality is discussed with each service user by their key worker on admission. Service users agree to the release of confidential information within the project where indicated that it is in their interest. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this 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 personal development of service users is given a high priority. Service users receive good support, in particular from key workers, to take part in a range of activities in the community and to acquire the skills and strategies to move to more independent accommodation. Evidence: Staff provide service users with psychological support through individual and group therapy, community meetings and through day to day interaction. A number of current service users have limited self care skills, as a result of their life styles and having spent a several years in hospital settings. The number of practical sessions with service users has been increased to reflect their need for additional support in taking care of themselves. Community meetings and sessions with key workers help service users develop ways of managing their mental health problems and symptoms. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: Three service users are taking part in education and one service user is starting a part-time degree course in September. Good use is made of local leisure and community services. Staff have identified that some service users need additional support to take part in community activities and are planning to introduce an Opportunity Group providing sessions initially within the house. The Manager said that the flat programme was being reviewed, as among other considerations, it isolated service users from the wider group, at a time when they needed support. The essential elements of the programme in relation to developing skills to live more independently will continue. The Care Coordinator for one service user is actively seeking accommodation for her in the community, as after spending two years at Lexham House, she is ready to live more independently. Service users and staff on duty sit down to an evening meal, which is prepared by service users with staff support. The Manager confirms in the AQAA that staff have continued to promote healthy eating and have encouraged those service users with weight problems to seek professional advice. Service users records show that referrals have been made to the Dietitian via the GP, with the service users agreement. The kitchen was clean and tidy at this visit, with good supplies of food including fresh fruit available. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff work closely with Care Management Teams and with other health care professionals to provide good psychological, social and health care support. The development of service users emotional resources to manage their mental health and live more independently is given a high priority. Senior staff have continued to take steps to improve the management of medication, which is generally good, although some errors and incidents have recently occurred. Evidence: While no service users need assistance with personal care, a number need prompting and support to improve their level of self care. Support is normally provided by staff in time-tabled practical sessions and as required. Records and discussion show that staff work closely with care management teams to ensure that service users receive good treatment and support. During the inspection staff were concerned about the mental health of one service user who was staying away from the project overnight and was refusing medication. His Care Management Team had been kept fully informed of changes in his behaviour and had met with him on a number of occasions. A case review meeting had been arranged for the following day. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: Closer working with the local Drug and Alcohol Team has been established and a number of service users attend individual sessions held at the house. All service users are encouraged to registered with a local GP practice. The Manager and Deputy Manager have continued to take steps to improve the handling of medication. Since the last inspection when the Pharmacy Inspector visited the project, a cupboard for controlled drugs has been installed and a small medication fridge. An audit of medication by Lloyds Pharmacy was recently requested by senior staff. The report of the audit on 6th June, which was satisfactory, makes a number of recommendations that have been implemented, for example regarding separate storage of creams and lotions. The Deputy Manager has drawn up a detailed list of the recommendations, which staff have signed to confirm that they have read. Following an incident in May, the sleeping-in room has been relocated to the basement and the office where medication is stored remains locked when not in use. The procedure for handing over keys has been revised and two staff normally administer medication. All new staff receive training in handling medication as part of their induction training held at CHTs head office. In addition, staff at the project undertake additional training and assessment. Further training for the staff team with Lloyds Pharmacy has been arranged. MAR sheets seen were up to date, with no gaps. Guidance on action to take as a result of a medication error and guidelines for Clozapine were available. The small stock of controlled drugs was safely stored, with records kept as required. Procedures for assessing and supporting service users to handle their own medication are in place. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users complaints and concerns are taken seriously. Incidents are well recorded and any safeguarding concerns acted upon promptly. Evidence: CHT has an established complaints procedure, which is displayed in the home. All service users receive a copy of the complaints procedure at admission, which is discussed by their key worker. Each of the 4 service users files seen during the inspection contained a copy of the complaints procedure, signed by the service user. The main forum for discussing issues is the community meeting, at which service users are encouraged to raise dissatisfactions or concerns about the service or interresident conflicts. Although no complaints are recorded in the complaints log, a complaint from one service user to CHTs head office regarding the possibility of having to share a room was seen on file. While it was clear that the service user had been supported to raise her concerns, a record of the complaint should have been noted in the complaints record, together with the outcome. A review of complaints should also be considered as part of the services quality monitoring system. Incidents are recorded in detail and relevant agencies, including CQC, informed. The number of incidents is high reflecting the challenging behaviour of some of the current service users. Records and discussion with staff show that a considerable degree of disturbed and acting out behaviour is tolerated, with boundaries established to keep service users and staff safe. One service user has been given notice to leave the project after several warnings about his behaviour and discussion with his care Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: management team. Service users vulnerability to financial abuse is considered as part of their risk assessment, with steps taken to try to protect people who are unable currently to manage their finances. Two safeguarding meetings have taken place since the last inspection, in line with local multi-agency procedures. All staff receive training in safeguarding adults provided by the local safeguarding team. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Communal areas and the kitchen are much improved, with attention paid to creating a pleasant and domestic environment. A good standard of cleanliness has been maintained. However substantial refurbishment is needed to provide service users and staff with more up to date facilities. Evidence: A tour of the building was made with two service users, including seeing their rooms. A programme of redecoration and replacement of furnishings has continued, with new carpet on the stairs and hallways and some redecoration of communal areas and bedrooms. Flooring in the bathrooms has been replaced as have the lavatory bowls, which had become stained. The sitting room and dining room were looking comfortable and attractive. The garden has been cleared, with seating and tables provided for service users. Staff report that good use is made of the garden. The two bedrooms seen contained all necessary furniture and equipment and one service user, who has one of the larger rooms has created her own space with a range of person possessions and decoration. The building which is cleaned by staff and service users, was clean and tidy. The maintenance officer visits regularly, carrying out repairs and redecoration. As noted in previous reports, the building would benefit from refurbishment to provide more up to date facilities for service users and for staff. The current layout is poor and Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: shared bathrooms and a double room contribute to a lack of privacy. Two female service users commented that they used only the top floor bathroom because they did not like having to share the first floor bathroom with service users who have different standards of hygiene. A plan must be agreed for the upgrading of the building when the present lease expires. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff support and training is of a high standard but steps must be taken to reduce the turnover of staff, including increasing the size of the staff team. Evidence: The service has experienced a high level of staff turnover since the last inspection, putting pressure on remaining staff to provide cohesion and stability for the staff team and for service users. Six staff out of the current team of seven have left during the past 12 months. While some staff clearly moved on to other employment, sometimes with CHT, as part of their professional development, senior staff spoken with believe that the pressure of work at Lexham House, in particular having to manage challenging and acting out behaviour, has led some staff to seek employment elsewhere. It is of concern that a further two staff are planning to leave shortly. Staff spoken with talked of the impact on service users of the high turnover of staff, as well as on themselves. Interactions observed between staff and service users were warm and positive. One senior member of staff commented that a lack of staff meant that insufficient time, especially informal time, was spent with service users. There are currently seven staff working at Lexham House, including the Manager and Deputy Manager. As the project is full with 11 service users, a number of whom present challenging and disturbed behaviour, urgent consideration should be given to Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: reinstating an additional post. In discussion the Deputy Director agreed that while CHTs other projects have similar staffing to Lexham House, the staff team is under considerable pressure both from the high turnover and the needs of current service users. The Deputy Director undertook to give prompt consideration to increasing the staff establishment to 8 posts, by covering the post of a member of staff on long-term sick leave. A sound recruitment system is in place, with all staff checks including CRBs undertaken by CHTs HR staff. Service users are involved in staff selection and normally meet with candidates at the project. Service users comments are forward to the selection panel. All staff at the project normally have a degree in Psychology and senior staff have also undertaken further training in group psychotherapy. New staff enrol on a 3 year training course leading to a Diploma or Masters in Group Psychotherapy, which is accredited by Middlesex University. Senior staff are studying at the Tavistock Clinic or the Institute of Group Analysis. All staff receive regular individual supervision and attend practice meetings. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this 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 service is well managed by a competent senior staff team. Service user involvement in the development of the project is valued and encouraged. CHTs Managers visit the service regularly to monitor standards and to support staff. Evidence: The Manager who has recently completed a Masters at the Institute of Group Analysis, is experienced in working in residential mental health services and has implemented a number of improvements in the project , in particular in developing a programme that meets the needs of service users. Quality assurance and monitoring systems are well established. CHT is a member of the Community of Communities, whose quality monitoring includes an annual peer group review. CHT is also involved in research projects to assess the effectiveness of its model of support and treatment. The health and safety of service users and of staff is given a high priority. All staff attend health and safety training as part of their induction. Records seen were up to date. The London Fire Service had visited a week before the inspection. A report of the visit was not yet available but staff confirmed that the visit was satisfactory. Fire drills Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: take place at least 4 times a year and all fire incidents are recorded. The fire alarm is tested weekly at different points. A monthly health and safety check is undertaken by staff. In addition the maintenance officer carries out a regular health and safety audit, which is recorded. The water system was tested for Legionella in June 2008. The hot water is tested regularly and shown to be at above 50C. As noted at the previous inspection, steps need to be taken to ensure that a service user, who has a physical disability, is not at risk of scalding. The Deputy Director of CHT visits the service at least monthly and reviews all service users in her monthly reports. The Manager and Deputy Manager attend weekly Managers meetings at CHTs head office in Fulham, where they have the opportunity to meet with colleagues as well as senior managers. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 22 22 All complaints, including lower level concerns, should be recorded in the complaints log. To ensure that follow up action is taken and to inform the projects QA monitoring. 31/07/2009 2 24 23 A plan for up dating the building must be available. To provide service users and staff with improved facilities, including more privacy. 30/09/2009 3 33 18 Steps must be taken to reduce the turnover of staff, including increasing the staffing establishment from 7 to 8 posts. To ensure that sufficient, experienced staff are available. stability of the 31/08/2009 4 42 13 Steps should be taken, including undertaking a risk assessment, to reduce the 31/07/2009 Care Homes for Adults (18-65 years) Page 27 of 29 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action possibility of one service user who is physically frail, from being scalded. To reduce the risks of scalding from hot bath water. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: 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). 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. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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