Inspection on 17/11/08 for Greig House

This is the latest available inspection report for this service, carried out on 17th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greig House 07/11/05

Greig House 18/04/05

Similar services:

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Herbert Street

Haven (The)

Charis

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Brook Drive, 124

Rugby House Project

City Roads Crisis Intervention

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Greig House Greig House 20 Garford Street London E14 8JG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anne Chamberlain     Date: 1 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Greig House 20 Garford Street Greig House London E14 8JG 02079875658 02079878942 rita.wooldridge@salvationarmy.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Rita Ann Carol Wooldridge Type of registration: Number of places registered: Salvation Army care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence Additional conditions: Date of last inspection Brief description of the care home Greig House is an 20 bed residential detoxification project. It operates a two or three week voluntary admission for detoxification from drugs and alcohol, for men and women aged 18 - 65. In addition to the registered care manager, project manager, and deputy project manager, the home employs a mixture of nursing and care staff as well as administrative and maintenance staff. They retain the services of a masseuse and an art therapist. A psychiatrist visits daily and a psychotherapist is in attendance for two and a half days a week. A keyworking system is in place. The treatment programme is holistic and in addition to medicated withdrawal complementary therapies are available, including acupuncture, massage, aromatherapy, and art therapy. Greig House comprises an older property and a new build. In addition to the bedroom accommodation and bathroom facilities there are spacious communal areas, and a number of office and meeting rooms. Greig house has one disability adapted Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 0 20 20 Brief description of the care home bedroom and disabled access to all ground floor areas. It is situated just off East India Dock Road close to transport links and with a number of community resources close by. The home is run by the Salvation Army and has been open for five years. The fees at Greig House are #905 per week for detoxification from alcohol and #1245 per week for detoxification from drugs. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was carried out on behalf of the Commission for Social Care Inspection (CSCI) and the terms we and us will be used throughout the report. The inspection was carried out over one day, taking some 5 hours. The aim of the inspection was to inspect all the key standards and to revisit requirements which had been made at the last key inspection. There are two managers in Greig House. The care manager and the centre manager. However the care manager is the registered manager of the service and any requirements are therefore addressed to her. Care Homes for Adults (18-65 years) Page 6 of 27 We were assisted by both managers. We spoke with two members of staff and viewed 2 service user files and two keyworker files, also key documentation and records. We toured the premises and inspected the arrangements for the administration of medication. We sampled lunch in the dining room. We would like to thank all who assisted us with the inspection of the service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 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. Individual needs are assessed before service users enter the unit and assessed again before they begin treatment. Evidence: The agency continues to accept referrals where an assessment has been undertaken by either a social worker or a nurse. This would include a check of physical health problems. Hwever all service users are assessed by the units doctor (a psychiatrist) on their first day of treatment. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user plans and risk assessments are individual and updated to reflect need. Service users are encouraged to take decisions within the boundaries of the programme. Evidence: Service users have an individual plan for care and treatment. This is reviewed every day and constantly updated by their keyworkers (a project worker and a nurse). We viewed the care plans of two service users, the most recently admitted, and a person who was about to be discharged. The building up and updating of care plans was evidenced. Decision making is necessarily limited by the nature of the service. Service users understand that they must abide by the rules of the establishment to complete their treatment. However the manager stated that the service is responsive to feedback from service users. Based on their views the practice of checking them during the Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: night has been changed. There are now fewer checks and these are based on a medical need basis. A general risk assessment is undertaken and the actions to limit risks identified are embedded in the care plan. This was evidenced in the files we inspected. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides education and occupation appropriate to its purpose. Access to the community is supported and so are relationships with friends and family. Food is nutritious, varied and pleasantly served. Evidence: The day starts with a gathering and a motivational statement. There are two group sessions every day and attendance at these is compulsory. Service users are allowed out into the community provided they are escorted by a member of staff, up until the eighth day of their stay. On the eighth day and after they are allowed out unescorted. Visitors are allowed but service users must take personal responsibility for the safety of any children who visit. Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: We ate lunch in the dining room with the service users. There was a choice of two dishes, one being vegetarian. There was a choice of fruit salad and cream, or yoghurt for dessert. Both courses were well presented, the first course was appetising and the fruit salad was fresh. The manager stated that in addition to the meals, alternative snacks are available. Service users can have food brought in and can shop for food items themselves. The manager stated that they get complaints from time to time about the food rather than any other aspect of the service. She said that they respond by making changes but feel that in a structured treatment programme food is a soft target for complaints and allows service users to express some of their negative feelings. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal emotional, psychological and health support. Medication administration is safe. Evidence: The service does not offer personal care support and service users must be independent in this. They cannot accommodate wheel chair users either. It is possible for a carer to visit the project to assist a service user, but not to reside. The manager stated that several service users with sensory needs have used the service. There are sometimes medical complications as a direct result of detoxification and these are well understood at the service. The manager stated that the local London Hospital is generally able to provide for medical needs which cannot be managed within the service. The psychiatrist retained by the service makes appropriate referrals for medical treatment. Sometimes service users are referred on for medical treatment after detoxification. Diabetic and epileptic service users continue with their usual self Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: medication although their supplies are locked away with the other medications. Emotional and psychological support are pillars of the service. In addition to the previously mentioned groupwork one to one counselling with keyworkers and the care manager are offered. We inspected the arrangements for the adminstration of medication. Because of the nature of the service they are complex, and medications are administered by trained nurses on all occasions. We raised that we have had no notifications of medication errors and the manager stated that medication errors are rare. Medication Administration Charts have photographs of service users to identify them. Prescribed medications are kept in separate drawers identified for service users. Stock medications are kept in another separate section. Service users bring medications into the project. If they are prescribed for them these medications continue to be used for them. They are not however counted when they are taken into the service. The manager stated that this would be too onerous a task for the service to take on. When service users leave they take the medications they brought in with them, including any balances of medications which they have been using. If medications are ordered the quantity coming into the home is known and the medication stock can therefore be checked. We sampled the medications for the two service users we were case tracking and found no discrepancies. Care Homes for Adults (18-65 years) Page 16 of 27 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. The home has policies and procedures for managing complaints but must follow them. They have a safeguarding policy but no procedure and are not clear about how safeguarding alerts should be handled. Evidence: We inspected the records of complaints. The record has a log at the front where complaints can be tracked. The log needs to be expanded so that the stages of the complaint process can be identified i.e. acknowledging the complaint, whether or not it was substantiated, when a response was made to the complainant, etc. It also contains a specimen of a complaints form. We noted that a complaint had been received on 7/7/08 about an incident on 2/7/08. The service replied on 25/7/08. This means that the complaint went unacknowledged for over two weeks, which is not acceptable and does not follow the service policy. The manager stated that there have been no safeguarding incidents since the last key inspection. She said that staff are trained on safeguarding once a year, although some refreshers are outstanding. We spoke to two staff members and the manager about how they would deal with an adult protection allegation. The view from all was that the manager would investigate. Following these discussions we were concerned that the training staff had undergone had not informed them on procedures to be followed in Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: the workplace. We were also concerned that the training certificate they were given lasts for three years. At present the national guidance document No Secrets is being reviewed and we feel that it is unrealistic to offer a certificate for three years in the area of adult safeguarding. We checked the safeguarding policy. It does state that the service must have a copy of the local authority policy and must work in conjuction with it. However at the time of the inspection the service did not have this document. They downloaded it soon after the inspection. Further the service does not have in place a safeguarding procedure to be followed. The manager stated that she will write one. Care Homes for Adults (18-65 years) Page 18 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the service is good, pleasant clean and hygienic. Evidence: We inspected the environment of the service, including some bedrooms. The premises are comfortable and well furnished. The decor is generally good but some painted walls need freshening. The manager stated that there is a redecorating cycle. There is some damp in the older part of the building which must be rectified. A bathroom in the mens section is in need of major refurbishment and the manager stated that this is planned. The home is clean and hygienic. Service users do their own laundry and the facilities for this are adequate. The manager stated that if there are any dressings to be disposed of they are collected by a contractor in a yellow bag, along with gloves, vomit bowls etc. Care Homes for Adults (18-65 years) Page 19 of 27 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 service is well staffed with clearly defined roles and enough people employed to cover all the work. However training in core basics is not regularly refreshed. Evidence: The service employs 20 staff altogether including 8 nurses and 8 key workers. There are 15 full time posts with 2 managers, a care manager and a manager for the building. There is an administration assistant, a receptionist and a person who deals with maintenance. The Home Uses some bank workers and occasionaly agency workers. The manager stated that bank staff have a file. They generally have other jobs where they receive training. We recommend that the manager carries out a probe into the training level of the bank staff. We viewed the files of two staff members. Recruitment is safe and robust with Criminal Records Bureau (CRB) checks being undertaken prior to staff starting work. One staff member had no photograph on her file and we recommend that all staff have photographic identification on their files. We noted from files that staff have induction and there is a comprehensive induction checklist. They have a contract and there is a Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: code of conduct. We interviewed two staff, keyworkers of the two service users we case tracked. One staff member was a nurse with a high level of qualification and sound experience. The other keyworker was a senior carer. He had four years experience and NVQ 3. Both workers very positive about all aspects of their supervision and management by the organisation. They felt that issues of equality and diversity were well addressed in the service. We viewed evidence of the training for the two staff members whose files we examined. According to the records supplied, the first staff member had had no training in 2007 or 2008 despite a renewal date of July 2006 being recorded against 4 items. The second had revewal dates of Jan 2008 and July 2008 x 2. The evidence did not clearly show us what levels of training the staff have and we are not satisfied that they are renewing core basic training, including Safeguarding of Adults on a regular basis. As previously stated we were concerned about the quality of the safeguarding training and felt that it is not reasonable to offer a certificate for three years. The manager stated that levels of supervison have improved and this was evidenced in the files we viewed. She further stated that staff appraisal was planned and training is taking place for appraisers. Care Homes for Adults (18-65 years) Page 21 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well run. Quality assurance is embedded in the practice and health and safety is promoted with safe working practices. Evidence: The care manager is the registered manager of the service and is responsible for meeting the regulations of the Care standards Act 2000. However duties are divided between the care manager and the centre manager which in our view could weaken the management structure. Quality assurance is undertaken with service users being asked to complete surveys before they leave. There are also weekly meetings and the manager stated that service users are generally well able to express their views. There is an audit system in place called QUADS which is specific to alcohol and drugs services. A yearly plan is made and was seen. A health and safety meeting is held quarterly and the minutes were seen. Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: We viewed the safety records for the service including the below: Fire risk assessment 2008 - Electrical circuits - hardwiring tested in 2006 Portable Applicance Testing - we were told that the maintenance man visually checks all electrical equipment which is brought into the service Evidence of weekly testing of fire alarms Evidence of regular evacuation exercises Emergency lighting weekly checks The recording of refrigerator temperatures The recording of the water temperature checks The cleaning is undertaken by an outside contractor. We viewed the arrangements for Control of Substances Hazardous to Health (COSHH) and noted that all substances are locked away. The cleaning supervisor showed us the COSHH assessments and data sheets and the sheets which evidence staff training. The records were kept loosely and some were out of date. We recommend that the old information is archived and the rest made accessible in a file. Care Homes for Adults (18-65 years) Page 23 of 27 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 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 22 22 The manager must 01/01/2009 acknowledge complaints and respond to them within a reasonable timescale. So that complainants have their concerns acknowledged. 2 23 13 The manager must ensure the policy states that in the first instance she must inform the local authority of any allegation or suspicion of abuse. A copy of the local authority policy must be kept in the office. 01/01/2009 To protect service users. 3 24 23 The damp in the older part of the building must be rectified. For the comfort and wellbeing of the service users. 01/06/2009 Care Homes for Adults (18-65 years) Page 25 of 27 4 35 18 The manager must ensure that mandatory refresher training is delivered to staff. This is a restated requirement the previous timescale of 01/01/07 not being met. So that staff are adequately trained for their roles. 01/03/2009 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 2 3 34 35 42 All staff should have photographic identification on their files. We receommend that the manager undertake a probe into training levels of bank staff. We recommend that the old information relating to COSH products and staff training on COSHH products, be sorted. Old information should be archived and current information made accessible. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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