Inspection on 22/09/09 for Closereach

This is the latest available inspection report for this service, carried out on 22nd September 2009.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Closereach 26/01/06

Closereach 02/09/05

Closereach 27/10/04

Closereach 26/05/04

Closereach 08/10/03

Similar services:

Clouds House

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Closereach Longcause Plympton St Maurice Plymouth Devon PL7 1JB     The quality rating for this care home is:   three star excellent 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: Megan Walker     Date: 2 5 0 9 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 30 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 30 Information about the care home Name of care home: Address: Closereach Longcause Plympton St Maurice Plymouth Devon PL7 1JB 01752348348 01752347555 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Broadreach House care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence Additional conditions: Age 18yrs Male only Date of last inspection Brief description of the care home Closereach is one of three residential centres owned by Broadreach House providing treatment programmes for recovery from alcohol and drug dependence. Broadreach House comprises of five services: Broadreach (mixed), Longreach (women only) and Closereach (men only) offer residential treatment programmes, Ocean Quay offers day services and Supported Housing can also provided. These are all located in Plymouth. Closereach is registered for continued treatment (post first stage detoxification) for drug and alcohol dependence for up to seventeen males over 18 years of age and up to of 65 years of age. It is a short stay centre, usually between three to six months. Closereach is not registered to provide nursing care or detoxification as part of the treatment programme. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 17 17 Brief description of the care home The house is in Plympton St Maurice, on the outskirts of Plymouth. It is arranged over three floors with access to all parts of the building via stairs. Major refurbishment to improve some of the bedrooms, and to provide new shower and toilet facilities and a bath was starting shortly after this inspection. All the bedrooms are shared and situated on the first floor. There is a dining room, a lounge and a further lounge/music room, both also used for group sessions, on the ground floor. Closereach benefits from well laid out gardens to the rear of the house and a large paved area to the side of house that are used for outdoor activities in good weather. Closereach provides counsellors and other support staff to maintain the programmes of care designed for the people who use the service. Closereach operates a no smoking policy. The current charges are £535.00 per week. These fees include all activities arranged outside Closereach. The fees do not include toiletries, clothes and other personal purchases. All the information relating to charges was provided to the CQC by the Registered Manager at the time of this inspection in September 2009. Care Homes for Adults (18-65 years) Page 5 of 30 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: three star excellent 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: This inspection consisted of an unannounced visit to Closereach by one inspector between 10.00am and 7.00pm on Tuesday 22nd September 2009, and a further announced visit took place between 2.00pm and 4.30pm on Friday 25th September 2009 at Ocean Quay. We last inspected this service on the 12th October 2006. Throughout this report, the term we is used as the report is written on behalf of the Care Quality Commission (CQC). An Annual Quality Assurance Assessment (AQAA) was completed by the registered manager prior to the inspection. The AQAA is a selfassessment that focuses on how well outcomes are met for the people who live in the home. A tour of the premises took place and records relating to care, staff and the home were inspected. We spoke to four people individually and others collectively about what is like to be on a treatment programme at Closereach. The Registered Manager was available for consultation and discussion during the inspection process. Also taken into account was the previous inspection report and all other information relating to Closereach received by the CQC since the last inspection. Care Homes for Adults (18-65 years) Page 6 of 30 Surveys for completion by clients, staff and health and social care professionals were sent to the service prior to the inspection. None of these had been returned at the time of writing this report. One requirement and two Good Practice recommendations were made as a consequence of this inspection. Care Homes for Adults (18-65 years) Page 7 of 30 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 Care Homes for Adults (18-65 years) Page 8 of 30 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 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 10 of 30 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. The information provided to prospective clients enables them to make an informed decision about admission to the home. The home has a safe admission procedure to ensure that clients make the best of the treatment available at Closereach. Evidence: We spoke to the men currently on treatment programmes at Closereach as a group and individually. They told us their care managers had given them a selection of written information about different rehabilitation centres in England, including Closereach. They all said they had had sufficient information to make an informed choice about applying for a place at Closereach. The people we spoke to had not had a visit to Closereach before they went there due to personal circumstances. The Registered Manager confirmed however that prospective clients can have an overnight stay if this is practical and feasible as well an informal visit. We looked at four care files. These all had an assessment of need and a review date had been set for approximately two months after admission. The application form Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: included the type of treatment programme being requested, for example, detoxification at Broadreach and longer term rehabilitation at Closereach or longer term rehabilitation at Closereach only. Each care file also had a copy of a letter confirming a place that was sent to both the care manager arranging the placement as well as the prospective client. This included the proposed date of admission. We also saw a Discharge form (reason for discharge ie planned end to treatment; does not wish to complete treatment; asked to leave treatment; referred on to ...)on each care file. All the information about treatment and outcomes is collated for the National Treatment Agency (NTA) purposes. Each care file also had a signed contract confirming the funding authoritys agreement for the placement. The process of assessment is completed by the Broadreach House Assessment and Admission Team, based at Ocean Quay. This team is responsible for all referrals to Broadreach House(*). The assessment may include assessment by telephone as well as consultation with the care manager and if possible, a meeting with the prospective client. Broadreach House has a website with downloads for all the services it offers and relevant forms at www.broadreach-house.org.uk. [(*) Broadreach House comprises of five services: Broadreach, Longreach and Closereach all offer residential treatment programmes and Ocean Quay offers day services. Supported housing can also be arranged as part of the Aftercare Plan. Broadreach House owns a 5-bedroom house and also has contracts with two housing associations for this purpose.] Care Homes for Adults (18-65 years) Page 12 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clients know their assessed needs and personal goals, including after care plans, are reflected in their individual care plan. Clients are encouraged to make decisions about their lives with assistance as needed and within any restrictions of their treatment programme. Clients are supported to take risks within realistic goals of their treatment programme. The clients quality of life, whilst in the home, is improved by having as much freedom and choice as possible, within the restrictions of the treatment programme. Evidence: The AQAA states We involve the individual in their care plan via a questionnaire/assignment called a Care Plan Assignment. Together the counsellor and client look at items that need to be targeted during their stay here. We are always mindful of how an individual might feel and what they are capable of. At the same time we encourage clients to push through boundaries that have hitherto held them back in life. We support them in their decisions, having first tried to ensure that they have made those decisions while in possession of all the facts. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Everyone we spoke to at Closereach was positive about his treatment programme and the support he received from the counsellors. One person told us that although he had an assigned counsellor for 1:1 sessions, the other two counsellors also offered him support. He felt that all three counsellors helped him cope with different issues he found himself facing up to and dealing with. Each counsellor, in their own way had also helped him to acknowledge issues he needed to work towards resolving. The men we spoke to collectively told us that there was a weekly house meeting that provided them with an opportunity to talk about day to day house matters. The registered manager confirmed this and told us there were also ad hoc house meetings if an issue arose that needed resolving quickly. A couple of people commented about the freedom they had at Closereach. They were both surprised by how much leeway they had and, initially, they both admitted they had tried to push the boundaries. The work they had done in 1:1 sessions and group sessions was helping them to learn about taking responsibility for their own actions and behaviour. All the care files we looked at had a full assessment and care plan. The average stay was five months. The funding was variable according to each local authority as to how it was paid, however a first review report was written after the initial eight weeks by the counsellors on behalf of their clients. This report gave the funder an update on the progress of their clients treatment programme, and was an opportunity for Closereach to request further funding if this had not already been agreed at the start of the programme. The Supported Housing Officer employed by Broadreach House and based at Ocean Quay, visits Closereach weekly. This is mainly to review housing needs with each client and his plans for after he leaves Closereach. The Supported Housing officer assists with applications for supported housing that can be provided through the Broadreach House contracts with two housing associations as well as its own supported housing property. Generally the expectation is if a client wishes to remain in Plymouth after his treatment programme and move into a supported housing scheme, he either attends day sessions at Ocean Quay, or attends college, or has a mixture of both. Clients are housed in a scheme for between six months up to a year and then assisted to seek private housing. Care Homes for Adults (18-65 years) Page 14 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clients have access to opportunities for personal development that will help during and after the treatment programme. Clients are able to take part in appropriate activities to ensure a good quality of life while living at Closereach. Clients understand and have agreed to limited access to the local community as part of their treatment programme. Clients rights are respected within the agreed constraints of the treatment programme. Dietary needs of the clients are well catered for with a balanced and varied selection of food available that meets the clients tastes and choices. Evidence: The men we spoke to were all positive about the opportunities they have at Closereach. As part of their agreement for treatment, they do not usually go off the Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: premises for the first two weeks. After this time they can go out with a senior resident although respecting that they stay within the limits of their individual programme. They are allowed to have a mobile telephone to be used only within the agreement of the treatment programme. The registered manager confirmed that a risk assessment had been undertaken before this was allowed and agreed. Its primary reason is because there are no staff sleeping on site. Anyone found misusing their telephone or being a nuisance to other clients would have their mobile telephone confiscated. Activities are varied and participation varies according to the group of men living in the house at any one time. One of the counsellors is responsible for organising activities. All activities are included in the weekly flat rate fees at Closereach. Weekly events include sports and gym, karate & Tai Chi. An Art teacher is due to be starting in October 2009 and there was anticipation that gardening would resume assisted by a volunteer at the project. Between April and October there were sailing trips for four days and up to four nights organised by a local charity with a qualified instructor/therapist. There are theatre workshops at a local theatre studio, led by the theatre staff. The clients at Closereach also benefit from opportunities to watch theatrical productions as well as put together their own shows. Staff signpost and support clients to join local Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) groups. Attendance at these is not however compulsory. Computer and literacy courses are available at Ocean Quay. For those men who stay at Closereach for six months, it is possible for them to take up voluntary work with a local volunteering organisation during the second half of their treatment programme. Bus passes and tickets are held by senior residents and given out as needed. The registered manager told us this was more cost effective than, as at the time of our last inspection, when each client staying at Closereach was issued with his own bus pass. The clients are expected to eat together at lunchtimes and evening meals as part of the treatment programme to encourage socialisation. They also have to clear away/wash up afterwards on a rota basis. Closereach has two cooks who divide the week between them. There is also a cleaner/kitchen assistant who covers each cook for holidays and sickness. All the meals were seen recorded including any alternative dishes for people with dietary preferences or health care needs. One day a week is used for hands on teaching, so clients can learn at least basic cooking skills to help towards their independence when they leave Closereach. The men take turns each Saturday evening to be responsible for choosing the menu and preparing the meal. These meals are planned with the senior cook mid week so the ingredients to be ordered. Care Homes for Adults (18-65 years) Page 16 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people on treatment programmes at Closereach can be confident that their physical and psychological needs will be met. The homes policies and procedures for dealing with medicines is safe. Evidence: The men stay at Closereach for between three to six months. They sign an agreement to participate in a treatment programme of rehabilitation and therapy. Each individual plan underpins support to overcome addictions and develop the necessary life skills needed to live independently without a dependency on drugs or alcohol. Emphasis is given to providing a structured environment in which the men can learn to live their lives in a different way. As part of the treatment programme group sessions as well as individual 1:1 counselling sessions are part of the care plan for each client. On the day of our visit one of the group sessions was a presentation of a written assignment. During an informal chat with the men before this presentation, they talked to us about the different subjects they each had ranging from a life story to an unsent letter. A counsellor explained that after the assignment was read, the other men were able to ask questions, challenge and/or encourage things they had heard in Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: the presentation. The group presentation would also be followed up in an individual 1:1 counselling session. We looked at four care files and these contained information relating to clients health care needs, as well as addressing physical and emotional well-being. There were also detailed records to monitor an individuals progress. These were maintained thoroughly and consistently by each of the counsellors for their clients. Contact information was recorded for any agencies or medical services that counsellors may need to liaise with about their client. At the time of this visit most of the men were relatively new to Closereach. The care plans were therefore more focused on immediate issues arising from starting treatment. Nonetheless the men were working towards outcomes after treatment. Those we asked told us that they are encouraged to make decisions about their future plans. The registered manager told us Closereach has a good working relationship with a local medical practice. In his opinion, the General Practitioner is sympathetic to this client group and works well with both the staff and the clients at Closereach. The medication policy at Closereach is for each client to be responsible for his own medication. At the start of a treatment programme any medication brought in by a new client is held and dispensed by the staff for that person. This is on average for about a week during which time the client is monitored for his vulnerability. There is also a check to ensure there is no previous history of suicide. We saw a written risk assessment of the risk of clients being responsible for their own medication. Generally the amounts of prescribed medication are maintained at a low level and are monitored by the counselling team regularly. All the counsellors have undertaken training in handling and dispensing medication. Care Homes for Adults (18-65 years) Page 18 of 30 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. Clients are listened to and complaints are properly managed. Procedures need to be put in place to ensure that all staff know how to protect vulnerable adults. Evidence: During our visit we observed that at Closereach there is an open culture that recognises clients rights to be protected from harm. The registered manager told us that the people who come to Closereach are vulnerable by the very nature of their reason for coming into Closereach. They are warned about the dangers of taking any substance after detoxification as it can be lethal. We saw a pamphlet on each care file we inspected. The registered manager told us a copy was given to every client. In the AQAA the registered manager wrote: Residents are aware that I, as the manager, will not tolerate intimidation, bullying, threats of violence, racism, or homophobia. They also know that my responsibility is to keep the house as safe as possible so that every individual feels safe to be who they are. Anyone who does not comply with the restrictions and boundaries of their treatment programme and/or is putting the other clients at risk by his behaviour is discharged from Closereach. This is a decision only taken after review and assessment and trying alternative methods of therapy and rehabilitation. The care manager is informed if their client is being discharged before the end of the treatment programme, and told Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: why. If a client has been discharged this is discussed in a group session to ensure that everyone clearly understands the reasons and rationale for a discharge. Likewise any behaviour that the clients consider should warrant discharge is discussed and a rationale for someone staying at Closereach is also shared with the group. Many of the clients at Closereach have little or no contact with their children, generally as a result of their addiction. Part of the treatment programme, if it is something the client wishes, is to work towards rebuilding broken relationships with any children they may have. One of the counsellors was booked to attend a training course about Hidden Harm. This is training initiated by the government and provided by local authorities within the framework of Every Child Matters. It is based on a report in June 2003 by the Advisory Council on the Misuse of Drugs (ACMD) on the needs of children of problem drug users and the serious negative affects such use has on children from conception to adulthood. It is also training that the counsellors may use with those of their clients who grew up in a household with a parent/other family members who habitually used drugs and/or alcohol. We discussed other training relating to safeguarding vulnerable adults, including the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS), and what it means for staff (therapists as well as care staff)working with people in registered care services. This is legislation that came into force on 1st April 2009 and applies to people living in services registered under the Care Standards Act 2000, regardless of who funds their place. The registered manager was confident that the counsellors had all undertaken training about recognising, managing and protecting people from harm. It was unclear however if the other staff members had attended any training about recognising and reporting behaviour that was inappropriate at Closereach. At the time of this visit the registered manager was made aware of the local authority training about safeguarding vulnerable adults based on the Department of Health guidance No Secrets. This training includes whistle blowing. Details of local training courses about the MCA DOLS were sent to the registered provider after this visit. Closereach has a written complaints procedure that we saw displayed on the noticeboard in the main hallway. It needed updating and the registered manager agreed to ensure this was done as soon as possible. The clients were well aware of how and to whom to make a complaint should they need to. They told us that they were encouraged to speak about any concerns relating to group living within the weekly house meetings and identify a solution together. They also told us that occasionally there were meetings during the week if an issue was escalating and could not wait until the weekly meeting. Care Homes for Adults (18-65 years) Page 20 of 30 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. Closereach is in need of refurbishment and redecoration however it provides a safe and hygienically clean environment for people staying and working there. Evidence: We spoke to the men staying at Closereach collectively about their accommodation. They all expressed satisfaction with their rooms. One person told us My room is great. I really expected a box room, pokey and small. Another person told us that he had been allowed to make the room [his] own. During our tour of the premises we found that most of the bedrooms had been personalised with photographs, posters and other soft furnishings of the persons choice. The rooms are not lockable and the men agree to this as part of their treatment programme. Most of the rooms are shared although at the time of this visit there were only nine clients. This meant that some of the men were on their own in a double room, on the understanding they may have to share at a later time. At the time of the last key inspection Broadreach House was expecting capital funding that could be used in part towards the refurbishment and redecoration of Closereach. For various reasons this did not happen at that time. Consequently although it was clean and tidy, the building on this occasion still needed redecoration and refurbishment throughout. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The registered manager was, however, able to confirm that funding has recently been agreed, a surveyor has drawn up plans, and a nominated builder is expected to start work shortly after this inspection. Proposed plans include raising the floors in the bedrooms so that people can see out of their windows, the showers and toilets room will be completely refurbished, and the urinals will be removed with a bath installed in their place. The floors in one lounge and the kitchen will be refurbished. There will be new curtains and lighting in the lounges and possibly new equipment in the kitchen. The registered manager showed us an area outside that currently looks like a shanty town of sheds. He was optimistic that there would be sufficient funding for a small gym to be built on this site instead. Care Homes for Adults (18-65 years) Page 22 of 30 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. The staffing levels and skill mix are satisfactory meaning peoples needs are currently being met at all times. There are some poor staff recruitment practices showing evidence of proper checks not being made to ensure that suitable staff are employed. Evidence: The staff team at Closereach is small however it was evident from observation and listening to the men on treatment programmes at Closereach that they felt supported by all the staff there. A couple of the men commented on the benefits they had received from a staff team that complimented one another with their individual skills and backgrounds. This included non-treatment staff. At the time of this visit all the staff files had been recalled to the Head Office at Ocean Quay for auditing purposes by the Human Resources (HR) Manager. We therefore by arrangement visited Ocean Quay to inspect files for staff working at Closereach. We looked at three staff files. The HR Manager had already identified that the two most recently appointed staff members had not had police checks prior to starting work at Closereach. She was therefore making appropriate checks to verify they were suitable Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: to work at Closereach. None of the files we looked at had photographs of the person. The HR Manager confirmed to us in writing the following week that all the staff working at Closereach had had their photograph taken and these were on the files. When all the staff files are complete they will be returned to Closereach. The HR Manager plans to visit each of the Broadreach House residential services monthly to deal with all HR related issues. We saw evidence of staff training including staff fire induction training and staff refresher training in fire safety and location of services. The counsellors had all attended training relevant to addiction counselling. One of the counsellors is booked on a child protection training course on Hidden Harm. The registered manager told us that he is looking for training that will help with recognising behaviour patterns. This is because some clients came to Closereach with a dual diagnosis so staff are prepared with some medical background before the admission. However when a client does not have any previous medical history to indicate a dual diagnosis, this could on occasions, impede or even undermine a treatment programme. The registered manager also gave us examples of people who had been misdiagnosed. In these cases, once the underlying cause of behaviour had been recognised as a wrong diagnosis, the counsellors and health care professionals had been able to address this and treat the person concerned appropriately. The HR Manager told us that a new induction programme is going to be introduced across all the Broadreach House services, based on Skills For Care. The HR Manager will oversee this. Closereach offers placements for students on the Broadreach House Diploma in Addiction Counselling course. On the day of this visit prospective students were visiting. The registered manager explained that a number of prospective students would visit and be assessed during that week. He emphasised how important this was to ensure the treatment programmes of the men were not hindered by someone not suited to a placement at Closereach. Once on a placement each student is expected to work towards taking on responsibility for at least one client during his stay at Closereach. The students nonetheless are supplementary to the counsellors. Care Homes for Adults (18-65 years) Page 24 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is effective and continues to develop the quality of the service so that clients needs continue to be met. The health, safety and welfare of clients is protected. Evidence: During this visit the registered manager was found to be approachable and keen to promote the welfare and general well being of the men staying at Closereach. As well as managing the home, the registered manager is also responsible for some of the counselling work. He is appropriately qualified, competent and experienced for his role as a counsellor and as the manager of the home. Since the last inspection the registered manager has written a Treatment Manual. He plans to edit and update the psycho-educational workshops so that any counsellor can run them. He has put together a Welcome Pack for all newcomers to Closereach. This explains about treatment and what someone on a programme could expect. In the AQAA the registered manager commented that, in his opinion, the information made available to prospective clients could be improved. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: We observed that Closereach is run in an open and transparent way with responsibilities delegated appropriately amongst all the staff. The clients were aware of boundaries and restrictions imposed upon them, and had these explained to them both at the beginning of their treatment programme as well when required during the treatment programme. On arrival new clients are given a Welcome Pack that tells them about treatment and what they can expect during their stay at Closereach. New clients all sign an agreement to allow information to be shared appropriately between multi disciplinary agencies. All the staff as well as the registered manager maintain a consistent approach to all the clients in encouraging them in their recovery. One person we spoke to told us that this helped him to respect the liberty he had rather than dwell on the limitations and boundaries of the treatment programme. Someone else told us that he was learning to be responsible for himself because the staff team each gave him the same message in their own way. There are weekly house meetings where the clients are able to talk about issues relating to the running of the house. This provides feedback for the staff about the service they are providing. Referrals to Closereach come from all over the United Kingdom. A wide network of social workers and probation officers as well as other referring authorities therefore use Closereach as part of the plan of care to meet assessed needs of their clients. This network forms part of the quality monitoring of the service as it also acts as a national grapevine promoting good practice or occasionally raising concerns about possible poor practice. Such incidents are clarified and resolved because Broadreach House is an approachable organisation that communicates its responsibilities to achieve its aims and objectives in the treatment of people who are dependent on alcohol and/or drugs. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 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 1 34 19 The Registered Provider must 02/11/2009 ensure that no person is employed to work at Closereach before all the required checks and references have been received and are satisfactory. These include a check against the Protection of Vulnerable Adults list, a Criminal Records Bureau check and a full employment history. If a person is employed in the home prior to receiving a satisfactory check from the Criminal Records Bureau, this person must be supervised by a designated staff member at all times, and must not escort anyone from the premises. This will give clear evidence that people using this service are protected by robust recruitment procedures. 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 Care Homes for Adults (18-65 years) Page 28 of 30 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 1 23 The registered provider should consider the local authority as well as in-house training for staff who are not qualified counsellors so that staff will be alert to any potential abuse, and know what action to take in the event of any allegation being made. This would also give them a better understanding and more insight into recognising and reporting inappropriate behaviour. The registered provider should consider training on the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DOLS) for all trained staff to ensure they are up to date with current legislation and practice. 2 23 Care Homes for Adults (18-65 years) Page 29 of 30 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. 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