We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

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1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Lakeside Mental Health Unit & Hounslow Community Services Twickenham Road, Isleworth, TW7 6AF Tel: Date of Inspections: 13 May May May 2013 Date of Publication: June 2013 We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services Care and welfare of people who use services Cooperating with other providers Safeguarding people who use services from abuse Staffing Assessing and monitoring the quality of service provision Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

2 Details about this location Registered Provider Overview of the service Type of services Regulated activities West London Mental Health NHS Trust Lakeside Mental Health Unit and Hounslow Community Services provide support to people with mental health needs who live in the London Borough of Hounslow. The inpatients units are for adults only, whereas the community services provide support to children, adolescents, adults and older people. Acute services with overnight beds Community based services for people with mental health needs Hospital services for people with mental health needs, learning disabilities and problems with substance misuse Assessment or medical treatment for persons detained under the Mental Health Act 1983 Diagnostic and screening procedures Treatment of disease, disorder or injury Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Respecting and involving people who use services 6 Care and welfare of people who use services 8 Cooperating with other providers 10 Safeguarding people who use services from abuse 12 Staffing 13 Assessing and monitoring the quality of service provision 15 About CQC Inspections 17 How we define our judgements 18 Glossary of terms we use in this report 20 Contact us 22 Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 8 May 2013, 9 May 2013 and 13 May 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider. We were accompanied by a Mental Health Act commissioner who met with patients who are detained or receiving supervised community treatment under the Mental Health Act We were supported on this inspection by an expert-by-experience. This is a person who has personal experience of using or caring for someone who uses this type of care service. What people told us and what we found This inspection was of the community services under the registered location of Lakeside Mental Health Unit and Hounslow Community Services only. The areas we inspected were the Hounslow community based services for children, adolescents and adults with mental health needs. The visits to these services took place over two days, with a third day to visit the Trust headquarters to provide feedback of our findings. This inspection was carried out as part of a pilot project of community based services. For this pilot we tested different ways of seeking feedback about the service from the provider and people who use the service. Part of the CQC role is to monitor the rights of people who are detained under the Mental Health Act 1983 (and subsequent amendments to this). This inspection also included a review of Community Treatment Orders by a Mental Health Act Commissioner (commissioner), on behalf of the CQC, the findings of which are referred to in this report. During our inspection we spoke with 24 people who use the service and three carers of people who had used, or were using the service. We also spoke with 22 staff and two student nurses. The feedback we received from people who use the service was generally positive about their experiences of receiving support and treatment from the community based services. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

5 However, people who we interviewed as part of the CTO review said they did not always understand their CTO or their rights in relation to this. You can see our judgements on the front page of this report. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

6 Our judgements for each standard inspected Respecting and involving people who use services People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run Our judgement The provider was meeting this standard. People's privacy, dignity and independence were respected. Reasons for our judgement Most people who use the service were given appropriate information and support regarding their care or treatment. People who use the child and adolescent mental health service (CAMHS) were able to refer themselves to the service to access support when they needed this. The staff told us about talks they did at local schools and community centres to raise awareness of emotional well-being and of the services available for young people. The young people we spoke with said that on accessing the service they had been given both verbal and written information about what they could expect, and this was provided in a way that they could understand. This included information on various therapies that were available, medicines that were used to treat people and their side effects. They told us that they felt listened to, treated with dignity, respect, consideration and were able to take part in making decisions about their care and treatment. One young person said "they have been really helpful, I don't know what would have happened if I did not come here". A parent of a young person who had used the service told us that the service was "like a life line" for them. The people who use the adult community services were generally very positive about the support they received. They said that they received information about their care and medicines, support groups they could attend, and the staff were empathetic and responsive to their needs. They told us they felt their complaints were dealt with quickly and where issues with staff's attitude had arisen appropriate action was taken to address these matters. A number of people spoke of the support they received to engage in activities, such as with cooking and healthy living, art groups and gym membership. In the community settings we saw information about groups and forums that people could attend for further support. For example there were support groups for people with bipolar illnesses and for young people and their parents/ carers. The provider might find it useful to note that people within the adult services were not always given appropriate information about their care and treatment. For example, when people were placed on a CTO they were initially sent a leaflet with information about the CTO and explaining their rights. However, people did not receive further information during Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

7 the course of the CTO to ensure they continued to understand their rights and what being on a CTO meant. They said they did not feel they were given clear information about being on a CTO, the legal implications of this, and they did not understand how they could come off the order. Some of the staff we spoke with in relation to CTO's also did not demonstrate a clear understanding of their role within CTO's, such as the reasons where people might be recalled to hospital. At the time of our visit there were also changes taking place within the community advocacy services which people did not know about, and so they did not know who to contact for this support. A number of people we spoke with said they were told they were involved in the 'recovery model' that is used by the Trust. However, they said they had not been given any information about this, to help them understand their treatment better. People who use the service understood the care and treatment choices available to them. People we spoke with and parents of children using the service confirmed that staff always explained what treatment options were available and their risks and benefits. Our discussions with staff showed that they understood the need to respect and value the people they supported. Family therapists and doctors gave us examples of the actions they had taken to meet people's needs in relation to disability, race, religion and belief, sexual orientation and age. For example staff told us they had worked with families from various communities that live in the Hounslow area to raise their awareness of mental health issues. The staff told us there were facilities within the Trust to support people from diverse backgrounds understand their conditions and treatment. They said the Trust could provide information leaflets in various languages and also had access to a range of interpreters, including those who could use sign language, if this was required. We observed that staff asked people about their communication needs and these were recorded so other staff were aware of these. People expressed their views and were involved in making decisions about their care and treatment. The young people we spoke with told us they were involved in making decisions about their care and treatment. This included whether they wanted to participate in therapy sessions and taking medicines. Within the adult community services people gave us examples where they had been able to change their doctor/ consultant where they were not satisfied with them. We were also given examples of people being able to decide at which community setting they wanted to have meetings held, to ensure it was somewhere that was convenient to them. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

8 Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. People experienced care, treatment and support that met their needs and protected their rights. Reasons for our judgement People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Staff we spoke with told us that they received referrals from the hospital, social services, GP and education services. The CAMHS and adult Assessment Team had a duty system to ensure staff were available to assess all referrals that were received regarding people who wanted to access the services. We spoke with some duty staff who told us that referrals were triaged and an assessment of risk was carried out, which could include speaking with the referrer and the parents of young people. Decisions were then made about the treatment, care and support people needed. These could include making emergency appointments for people to be seen by an appropriate mental health professional, people being given an appointment at a later date, or directed to more services appropriate to their needs, such as their GP. In some situations where people were referred back to their GP, the community mental health service would advise on treatment or medicines to be prescribed. All the staff we spoke with told us that risk and safety were central to the work they carried out at the service. The young people we spoke with told us that risk and safety was regularly discussed with them. Comments about the service we received from them included "it has kept me calm, stopped me from doing things, it has kept me safe" and "they do a good job at keeping you safe". People who use the adult services told us that they were given details of who to contact out of hours, and when they needed more support. People said that where they had used these services staff engaged with them in a way that made them feel safe. In all the community services we visited, the staff told us about the DNA (does not attend) policy, when people did not turn up for appointments and the risks that this might entail. They were aware of the actions they needed to take in these cases to ensure the safety and welfare of the people and that of others. This could include attempts to make contact with the people, assessments of risk, home visits or referrals to people's GP's. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. All the people we spoke with and parents of children who had Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

9 used the service told us they were happy with the care and treatment provided and that this met their individual needs. Comments we received from parents included "they have always helped me" and "if the staff here don't know, they find access to someone who does". This showed that people were getting the care and treatment they needed. We looked at the care records for a number of people across the services. These detailed the needs of the individual and how their identified needs were to be met. We saw that areas of risk were incorporated into the plan of care and detailed how the risk of harm was to be managed. People using the service told us that they could have a copy of the care plan if they wanted. The care plans for people who use the CAMHS had been developed into a letter format, which they said were more suited to them. These covered various aspects of their needs such as social, psychological, physical, relationships and money management, with clear identified goals and an emphasis on promoting their independence. There were goals and interventions for the young person to follow, which helped people to take responsibility for themselves. For people using the CAMHS an easy read version of their care plan was available, which focused on a review of what the person had done well and achieved so far and, self help strategies for challenging times and future goals. The care plan used positive reinforcement of achievements and encouraged the person to be motivated and take responsibility. However, the provider might find it useful to note that people who used the adult services were not always given appropriate information about their care and treatment and that they did not always receive these in a timely manner. For example we found that staff who supported people on a CTO did not feel trained and were not aware of protocols to follow to support people on a CTO. They told us that the CTO conditions were often generic and not individualised to each person. We saw examples of this. One person's CTO stated 'engaging in therapeutic activities'. It was unclear what this meant. Another person who was on a CTO said that they had been waiting for psychological treatment for approximately 20 months. Similarly, our findings from the adult community teams showed that there was a two year waiting list within the recovery service for people to access psychology services. To manage this staff told us that they kept people informed and offered them alternative therapeutic interventions, such as coping strategies, emotional and practical support. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

10 Cooperating with other providers People should get safe and coordinated care when they move between different services Our judgement The provider was meeting this standard. People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. Reasons for our judgement People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the Trust worked in co-operation with others. The Trust told us that the CAMHS had positive working relationships with members of the multidisciplinary team, such as speech and language therapists, physiotherapists and community pediatricians. The young people we spoke with told us that various professionals were involved in their care, such as teachers, therapists, doctors, youth justice and social workers. They also told us that staff sought their consent to receive and share information with other professionals where possible. We saw evidence of this in the care records we viewed. During our inspection of the CAMHS service we met a range of professionals that worked with children, young people and families. Staff told us that they worked together to support people when they transitioned through various services and as they moved through different stages of their lives. For example, when young people transferred from primary to secondary schools or when young people transferred into adult mental health services, staff worked together to ensure a smooth transition from one service to the other. Staff worked well with other healthcare professionals within the community to ensure people received safe and appropriate care. One doctor told us that they worked closely with the cardiologist at the local hospital to monitor the side effects of some of the medicines that some children were taking. The duty staff we spoke with told us they worked with the local accident and emergency department, so that they were informed of the admission of people with mental health needs to ensure their needs were appropriately assessed and managed. Within the adult services people told us about the support they received from social workers, occupational therapists and groups within the community that they had been referred to. We found that there were positive links with GP services, the police, child protection teams and criminal justice teams. Within the Assessment Team there was a dedicated phone line for GP's to use to seek advice and a consultant was available at certain times for GP's to talk with. GP's were also contacted throughout the assessment process to ensure that staff had current information. Following the assessment, copies of Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

11 care plans were sent to GP's to ensure that they were kept informed of the treatment and support that people received and would require in the future. There was joint working between the inpatient services and the Home Treatment Team in making decisions on the best place for a person to receive treatment, whether in the community or in hospital. Where a person had been admitted into hospital the community staff were involved through visits and attending relevant reviews of the person's care, to ensure a consistent level of support to the person. The Trust used a computerised system that was accessible to all relevant staff, including inpatient and community staff to record the care and treatment that people received and their support plan. This ensured the appropriate sharing of information to promote continuity of care and to safeguard the welfare and safety of people. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

12 Safeguarding people who use services from abuse People should be protected from abuse and staff should respect their human rights Our judgement The provider was meeting this standard. People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Reasons for our judgement People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. All the people we spoke with said they felt safe using the service and would be able to raise any concerns with their doctor, therapist or team manager. The staff told us that they had undertaken child protection or adult safeguarding training in accordance with their role. Records we viewed confirmed the training that staff had undertaken to keep their skills and knowledge up to date so they could care for people effectively. The staff were clear about the procedures they would follow if they suspected someone was at risk of abuse. They gave us examples of instances where they had had safeguarding concerns, which were discussed within the team and raised with the local authority safeguarding team so appropriate action could be taken to safeguard people. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

13 Staffing There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement There were enough qualified, skilled and experienced staff to meet people's needs. We asked parents of children and people using the service if they thought that there were enough staff to provide the necessary care and treatment that people required. They all told us there were enough staff to meet their needs. People said that staff were "respectful" and "trustworthy" and they were generally always seen at their appointment time, and managed to see who they wanted to. Comments we received from parents included "everyone is so friendly, if I have any problems I would speak to them" and "very supportive". We noted that there were staff vacancies within all the teams we visited. The majority of these were covered by locum staff. The provider might find it useful to note that the feedback we received from staff about the staffing levels was mixed. The senior managers told us that some posts that had been vacant for a while were in the process of being recruited to. However, staff within the teams we visited spoke about a 'recruitment freeze' that was taking place at the time within the Trust. Some staff felt that despite the vacancies, there were no risks to people who use the service, because they worked together as a team to share the work and support each other. However, staff in the recovery teams spoke about a number of 'unallocated cases', where referrals had been made to the service but had not been allocated to a member of staff. This meant that people could be placed at risk if they had to wait to receive treatment and care. We were told by team managers that the system used to measure each staff members caseload was monitored every week for complexity and the skill mix of staff. However, those within the adult services also acknowledged that there was a lot of 'goodwill' in team, where staff worked extra hours to complete their work. Staff were skilled and competent to make sure people received safe and appropriate care. They told us that they were flexible in the way they worked to ensure that people had positive outcomes. They reported they worked well within their teams and that there was a good skill mix of professionals within each team. They confirmed they received training, and felt supported by the staff that worked with them. All staff who worked within the Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

14 community teams had a professional qualification, such as nursing, occupational therapist or psychologist, apart from those who were trainee's and who worked under the supervision of a qualified professional. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

15 Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Reasons for our judgement We asked West London Mental Health Trust how they monitored the quality of service provided by Hounslow Community Services. Some examples they gave were through feedback from the Patient Advice and Liaison Service and learning lessons from any serious incidents. In the community settings we were shown evidence of meetings and actions that had been taken in response to incidents to minimise the risk of these happening again. The Trust told us about the action they had taken in relation to the recent Francis report, which included a critical self-assessment, cascading of the findings throughout the Trust and asking staff whether they had come across similarities whilst working for West London Mental Health Trust. Where areas were identified the Trust had made recommendations for improvement, in line with those identified in the Francis report. Most staff we spoke with said they had received information from the Trust about the Francis report, whereas others said they had accessed this on their own. Staff within the CAMHS service told us that the recommendations of the report had been discussed within their teams and that work to improve the service in light of these was under review at the time of our inspection. People who use the service, their representatives and staff were asked for their views about their care and treatment. The Trust told us that people who use the service and their carers were listened to and had set up several service user and carer forums across the Trust. We found that within the adult community service there was a service user forum for people to talk about general issues that affected them and changes within the Trust. There was a service user lead person for the community who attended monthly management meetings within the different adult community settings. The Trust told us about the 'Meridian Patient Experience Feedback' system that had been introduced to gain timely feedback from people who use the service. This is an electronic way of receiving feedback from people by them completing a satisfaction questionnaire on a tablet computer which was available in the waiting areas. At each community setting we visited they told us about the 'Meridian system' that was used to collate real time information from people who use the service. In the CAMHS we saw these had been Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

16 specifically designed for different ages of young people, although no analysis of results had taken place. However the provider might find it useful to note that the arrangements to receive feedback from people within the adult services were not as developed. They did not yet have the 'Meridian system' in use and, whilst senior managers within the Trust carried out monitoring visits across the inpatient services, no visits had been carried out to community services throughout 2012 and This meant that these services might not have been getting the oversight from senior managers that other services received. Decisions about care and treatment were made by the appropriate staff at the appropriate level. A review of the Trust Board meeting minutes showed that areas such as the quality strategy and results of the NHS staff survey 2012 were discussed and improvement strategies decided upon that would benefit the Trust. We saw that various arrangements were in place to ensure people receive safe and appropriate care. Within each Clinical Service Unit and community setting there were team based Clinical Improvement Groups which discussed and agreed plans for improving the efficiency of community services in areas such as alternatives to inpatient admissions, embedding of the recovery approach and joint initiatives with external service providers. Within the community settings there was evidence that Clinical Governance audits took place, which covered quality indicators, such as number of incidents, complaints and staff training needs. Team managers also spoke about being engaged in regular audits of the service that was provided in their specific area. For example, in the adult Assessment Team this entailed measuring the quality of initial assessments that were carried out, use of evidence based research, and meeting targets in line with the Care Programme Approach, to ensure that people's care and treatment was regularly reviewed. Within the CAMHS team we were given examples of how staff measured quality by evaluating the effectiveness of some of the groups they ran, and of their referral processes. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

17 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

18 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

19 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

20 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

21 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

22 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) 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. Inspection Report Lakeside Mental Health Unit & Hounslow Community Services June

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We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Nuffield Health Newcastle-upon-Tyne Hospital Clayton Road, Newcastle

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We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Darna House Groby Road, Altrincham, WA14 2BQ Tel: 01619284342

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We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Spire Gatwick Park Hospital Povey Cross Road, Horley, RH6 0BB

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We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. St Austell Dental Centre 28 East Hill, St Austell, PL25 4TR

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We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Eastbourne Villa 21 Eastbourne Road, Hornsea, HU18 1QS Tel:

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We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Kingston Hospital Galsworthy Road, Kingston Upon Thames, KT2

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We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Mayfield Dental Centre High Street, Mayfield, TN20 6AW Date

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We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Human Touch Ambulance Ltd 111-113 Spalding Road, Deeping St

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We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Florence Nightingale Care Home 60 Village Street, Normanton,

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We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. The White House 95-97 Maidstone Road, Chatham, ME4 6HY Tel:

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