Inspection on 10/05/05 for Allington House

This inspection was carried out on 10th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Allington House 18/10/07

Allington House 18/10/06

Allington House 17/10/05

Allington House 12/10/04

Allington House 05/05/04

Similar services:

Clouds House

Closereach

Westcliffe House

Hilldales

Longreach

Chandos House

Cherry Orchards Camphill Community Ltd

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Allington House 46 Dean Park Road Bournemouth Dorset BH1 1QA Lead Inspector Julia Mooney Unannounced 10 May 2005 10:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Allington House Address 46 Dean Park Road Bournemouth Dorset BH1 1QA 01202 293660 01202 293660 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Streetscene Mrs Karen Mary Mills CRH (PC) - Care Home Only 16 Category(ies) of D - Drug dependence past/present (16) registration, with number A - Alchohol dependence past/present (16) of places Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 12th October 2004 Brief Description of the Service: Allington House is a residential unit run by Streetscene, a registered charity which operates a total of three residential units, two of which are situated in Dorset the other in Hampshire. Allington House provides primary care and support for people recovering from dependence on drugs or alcohol. The home is registered to accommodate up to 16 residents. There are 10 single bedrooms and 3 shared bedrooms, none are en-suite. The duration of stay at the home is 12 weeks, the service users can then move to the secondary care house a short distance away (Anderson House) where the stay would be a further 12 weeks. If accepted on to the treatment programme, service users must agree to the various house rules and restrictions imposed. (These are detailed in the body of this report) Allington House is situated within easy walk of Bournemouth town centre. There is also good access to local and national bus, coach and train routes. The property was originally built as a family house, it is detached and in a residential area of the town. The home has a large garden with garden furniture and a wooden framed shelter where service users are able to smoke. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and started at 10:30 on 10th May 2005. It was conducted as part of the normal routine of inspecting twice during a twelve month period. The Registered Manager – Karen Mills, the service users and staff all assisted the Inspector in the work. Methodology used included a tour of the premises, review of records and discussions with service users and staff. The inspector also reviewed the contact sheet for Allington House held at the Commission for Social Care Inspection office and various documentation submitted by the registered provider in response to requirements made at the last inspection. Not all of the National Minimum Standards were assessed on this visit. Please note where a National Minimum Standard was not assessed the score is shown as x. What the service does well: The home has an excellent comprehensive Statement of Purpose providing the reader with sufficient details to make an informed choice about whether to live at the home. Each service user is fully assessed prior to and on admission, and the home is completely flexible in its approach to trial visits. A formal contract of residence ensures security of placement. Records indicated that service users were involved in the formulation of care plans and reviews and service users spoken with confirmed this. Service users’ also confirmed that they were very involved in the day to day running of the home e.g. cook meals, domestic chores to keep the home clean, speaking with prospective service users when they visit the home. Service users’ personal and healthcare support is comprehensively met at Allington House and there are satisfactory systems in place to protect them from significant harm or abuse. The home keeps a well maintained record of incidents and recently added an “Illicit Drugs” record which is completed when illicit drugs are found at the home or handed in to staff. Service users are supported by a sufficient number of key workers who are experienced in the field of addictions. Service users spoken with confirmed that the staff team are “friendly”, “caring” and “supportive” of the resident group and colleagues. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 6 Policies and procedures at the home are plentiful and comprehensive and are regularly reviewed to ensure that service users’ best interests are safeguarded. Generally speaking, the home promotes good practice in relation to safeguarding the health, safety and welfare of service users. What has improved since the last inspection? What they could do better: The lifestyle and social interests of service users accommodated at the home are varied and promote independence. Service users spoken with were involved in various activities such as attending support meetings, going to the Gym, regular visits from family however, no reference relating to personal interests or contact with family and friends was found in personal files/care plans. Care plans must be regularly reviewed and the reviews must contain detailed information. The homes’ fire training record should give sufficient detail as to the content of the fire training session. Copies of valid Gas and electrical certificates should be forwarded to the Commission for Social Care inspection by 31st July 2005. Although staff are experienced in working with addictions, the registered provider must ensure that 50 of care staff have obtained NVQ 2 and the registered manager NVQ 4 by the end of 2005. In addition, staff must receive support and regular supervision and have an annual appraisal. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3. The homes Statement of Purpose provides current and prospective service users with sufficient details to make an informed choice about admission to the home. Pre-admission and admission assessments are comprehensive to ensure that the needs and abilities of each service user is met. The pre-admission assessment and visits to the home offer the prospective service user time to ascertain whether their needs and aspirations can be met during treatment at the home. EVIDENCE: Since the last inspection the registered provider has produced an updated Statement of Purpose/Service Users’ Guide which was examined by the inspector on this occasion. It contained relevant information about the home, including the aims, objectives, facilities and services. Service users spoken with confirmed that they received a copy of the homes’ Statement of Purpose/Service users’ Guide prior to admission. Prospective service users undergo a full assessment by professionals trained to do so. However, there are situations where pre-assessment takes place over the telephone e.g. referral from HM Prison. When this happens, background Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 10 information is sought prior to the telephone assessment and a trial period of 4 - 6 weeks is offered to the client. During this time he/she is continually assessed and fully participates in the process. Assessment documentation includes a planned 12 week programme individually tailored for each service user. Service users spoken with stated that assessment prior to admission was “very thorough”, “it took the prison worker a long time to complete the paperwork”. They had been assessed by Probation Officers, prison team, Care Managers and members of staff at Allington house. Allington House provides excellent support for individuals recovering from addictive disorders. Group and individual work is available to service users from staff trained in this specialist field. Staff files evidenced qualifications/certificates of achievement. Service users spoken with made positive comments about the experience of staff at Allington House. “It’s good that staff have an understanding of addiction”. “They go out of their way to help you” Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9. Service users spoken with confirmed that they were very involved in formulating their care plan to include their identified needs and how these goals and aspirations might be achieved. Service users are enabled to make decisions about their lives with the restricted parameters available which form part of their treatment programme. e.g. they may not go out alone whilst participating in the treatment programme. Each person has a personal risk assessment on file with the aim of promoting independence. They are regularly reviewed, signed and dated by the service user and key worker. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 12 EVIDENCE: The inspector noted a marked improvement in the standard of recording in care plans. The plans now provide more detail of individual treatment programmes. There is an action plan and how the objectives will be met by the service user and his/her key worker. They also detail health matters including any disability, Orders from the Court and whether this entails any restrictions etc. However, as on previous occasions, detail relating to contact with family/friends was scant. In addition, the plans do not reference the social needs and aspirations of each person. Plans were signed by the service user and key worker and dated. Care plan reviews did not contain sufficient information, something that has been raised at the home on more than one occasion. The inspector offered advice on completing care plan reviews. Five care plans and treatment progress notes were examined by the inspector on this occasion. The progress notes were particularly informative and offer the reader an up to date picture of each service user accommodated at the home. Service user files evidenced that during the first few weeks’ further assessments take place e.g. social history, relationship history and chemical dependence history. The file also contains a written self-assessment completed by the service user. The manager informed the inspector that a Dictaphone was available for service users who are not able to read or write. Records kept at Allington House indicate that the service users are fully involved during his/her stay at the home. Some service users day to day movements are restricted (but they are aware of this before accepting treatment and it is clearly stated in the homes’ statement of purpose) e.g. specific Orders from the Court such as being fitted with a tagging device, not being allowed out of the home on their own in the initial phase of their treatment programme and there is a system in place allowing service users to withdraw money from their funds. Due to the nature of their problems, it is felt by the management of the home that having access to cashpoint cards, cheque books etc may jeopardise their recovery. The system requires the service user to give staff 48 hours notice to withdraw from their funds, service users spoken with felt the system to be adequate. Risk assessments are completed prior to admission and continue to be reviewed throughout the service users stay at Allington House. Five risk assessments were examined on this occasion. Recording had improved since the last inspection and all risks such as window restrictors, health risks, whether the service user is self medicating, or subject to restrictions of the Criminal Justice Act are included on the pro-forma and the action necessary to minimize the identified risks is also recorded. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16,17. Staff promote personal development for service users as much as possible in their daily lives, and within safe boundaries in the home environment and wider community. Service users have ample time for activities, social interests and relaxation within the home and community, however, no reference is made to this fact in their personal files. Service users have much contact with family and friends but again, no reference is made to this fact in personal files/care plans. Staff respect service users’ rights and recognise that they have a responsibility to enable service users to exercise as much control over their daily lives as possible within the restricted parameters of their treatment programmes. The meals offered choice and variety and service users were involved in menu planning. Meal times are relaxed and very much a social occasion. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 14 EVIDENCE: Service users lead a full and varied lifestyle during their stay at Allington House. To aid their recovery, attendance at Alcoholics Anonymous/Narcotics Anonymous is expected as often as 5 times a week. An AA meeting takes place at the home on Sunday evenings. Ex-service users regularly visit the home to speak with the resident group. Individual and group therapy form part of the daily routine at the home and the programme is delivered by competent staff, some trained and others currently in training for recognised qualifications in the management of addictions. The weekend regime consists of completing cleaning schedules, the opportunity to attend the local church on Sunday morning, watching a DVD on Saturday evening and the opportunity to go out shopping or maybe get a haircut on Saturday afternoons. Once a month a mini bus is available for outings. Clients choose what they would like to do and trips have included bowling, walks, cinema, the gym at YMCA, playing football etc. The inspector could find no reference to social needs and aspirations in service users’ care plans. The regime at Allington House does not fully lend itself to finding and keeping appropriate jobs or continuing education/ training or voluntary work. These activities are offered when service users move on to the next stage of their treatment programme. However, learning about themselves, their addiction, learning new coping strategies and skills whilst experiencing a lengthy period of being drug/alcohol free, prepares service users for the secondary phase of their recovery programme. An education team at the college is linked to Information Technology training provided at Allington House on Tuesdays. The home has one computer which service users are able to access. It is an accepted part of the treatment programme at Allington House for service users to be accompanied by staff when they wish to go out. However, as their stay progresses, it is hoped that trust develops between service users and staff to the point that clients are able to go out alone towards the very end of their programme. In addition to the social pursuits mentioned above, service users also take part in volleyball games at the local YMCA once a week and the home has just begun Tai Chi on Monday afternoons, this session is run by a volunteer. Service users at Allington House have an element of choice regarding their leisure activities. The nature of recovery programmes does mean a curtailment of certain interests and hobbies such as playing darts in a public house. However, leisure activities currently available to service users include volleyball, cinema trips, playing football, outings, watching TV & DVD’s and playing board games. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 15 Service users choose the level of involvement they want from their family and friends. Visits from families and friends are permitted on Sundays until 5pm. Again, this is an accepted part of life in a treatment programme. Service users spoken with did not have a problem with this restriction. There are rooms in the home for service users to talk privately with their family or friends. Staff are not at liberty to disclose information about the service user unless he/she has specifically requested his/her family or friend be involved. Although the inspector was able to find reference to family links and friendships in service users individual plans, the information was scant. The routine is fairly strict at the home as one of the aims is to add structure to service users’ lives. Dish washing, clothes washing and cleaning are all part of the daily routine tasks completed by service users on a rota basis. Toilets & bathrooms have locks to ensure privacy but bedrooms do not have locks. The rationale for this is clearly stated in the homes’ Statement of Purpose/Service Users’ Guide. The manager stated that as part of the homes’ routine, all rooms are checked at 9.30am for tidiness, service users are not usually in their rooms at this time of day. The treatment programme at Allington House needs full co-operation and participation from service users if they wish to complete the programme successfully, to this end, they are unable to choose whether or not to take part in an activity. To safeguard against drugs coming into the home, certain mail is opened in the office and in the presence of the service user. Similar restrictions are in place with regard to going out alone and having access to their money. These restrictions act as safeguards and are an accepted part of everyday life in a recovery programme. Rules on smoking, alcohol and drugs are clearly stated in the home’s contract. The home’s Statement of Purpose and Service Users’ Guide clearly states all the restrictions that apply to service users during their stay at Allington House. Menus at Allington House are decided by the client group with the assistance of staff. Menus were examined by the inspector. A four weekly menu rota exists with alternatives available for anyone not wishing to eat the planned meal. In accordance with a requirement made as a result of the last inspection, the home now has a clear record of all three meals eaten by service users during the course of a day. The manager stated that currently no one at the home has special dietary needs, but if a special diet was required, it would be recorded on the pro-forma. The inspector noted that service users nutritional needs were addressed as part of the assessment documentation. Meals are served at set times due to the daily schedule of the house, beverages are available at any time of the day. Service users prepare and cook meals and wash the dishes afterwards. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20. Service users at Allington House gain much support from their peers during the treatment programme. Staff also support them in trying to rebuild their lives. Service users’ physical and emotional needs are comprehensively met to ensure that they gain maximum benefit from their treatment programme. Staff encourage service users to retain their own medication. This enables them to maintain some control over their daily lives and instil a feeling of trust and responsibility. EVIDENCE: When admitted to Allington House service users are generally admitted by a member of staff the same sex as themselves. Their designated key worker is allocated at random but should the service user request a change then this is permitted. Key worker sessions are always conducted in private. Key worker notes were examined and were up to date. Whilst bed times are flexible, service users are expected to be in their rooms by 11pm. Baths/showers are available after 5pm or by 8am. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 17 The healthcare of service users at Allington House is provided by Boscombe Manor Health Centre. Service users undergo a full medical within the first two weeks of their stay. The home provides guidance and support regarding issues such as HIV infection, hepatitis etc but service users are encouraged to take control and manage their own health issues. Dentists and opticians can be accessed should a service user require one during their relatively brief stay (12 weeks). Staff would usually accompany a service user to outside appointments unless he/she was nearing the end of their treatment programme. Service users health is monitored by their key worker throughout their stay. The inspector examined the homes’ accident and incident books. Recording in both had improved since the last inspection and the manager signs the books every quarter to acknowledge that she is monitoring accidents and incidents at the home. There were numerous incidents 11 of which necessitated a Regulation 37 report to the Commission for Social Care Inspection. Both records evidenced that appropriate action was taken by staff. During the last inspection, the inspector advised the manager to set up an illicit drug record as illicit drugs had been handed to staff on several occasions. The manager had done this and the record was well maintained and evidenced that the Police were called on each occasion. Over the past year the home has received advice and guidance from the Pharmacist from the Commission for Social Care Inspection and from a leading High Street Chemist regarding their medication system. This was due to the fact that previous inspections highlighted problems with the homes’ medication system. On this occasion, the inspector found a very well maintained system for ordering, administering and disposal of medication. From speaking with the manager it was clear that she had spent an inordinate amount of time checking that staff were trained and that they fully understood the training. Checking blister packs, medicine stocks, staff signatures etc has finally paid off and the effort she has made in getting a workable system in place at the home is commendable. A record was available of all medication received including medicines that the service user wished to retain to self administer. Staff recorded the date when the medication was first opened/started and whenever it was actually administered to the service user i.e. the time of day. (This corresponded with the prescribed instructions on the box/packet). Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 18 Four service users were retaining their medication and had a Medication Administration Record chart clearly recording what medication they had in their own possession, what quantity, the date they received the medication and the date they started the pack/bottle. Both service users had a risk assessment with regard to self administration of medication on file. A lockable space is available in service user’s rooms for the purpose of storing medication. The system for medication waiting for disposal/collection from the chemist had also improved, when it is collected, a signature is now obtained from the chemist to acknowledge receipt. All staff employed at the home have received handling medicines training by the manager who cascaded training she had received from a representative from a High Street Chemist and Pharmacist from the Commission for Social Care Inspection. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23. Service users stated that their “views are listened to and action is taken when we raise issues” This assures service users that their views are taken seriously by staff. The home had satisfactory systems in place to protect service users from significant harm or abuse. This means that service users know they are safe and will be supported by staff in their recovery programme. EVIDENCE: The inspector examined the complaints record. No complaints had been recorded since the last inspection. The home has several policies and procedures relating to safeguarding service users from physical, financial, material, psychological or sexual abuse e.g. Violence at work, Managing service users money, valuables & financial affairs. A whistleblowing policy has been developed and the home has an adult protection procedure which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets. Physical and/or verbal aggression by a service user is dealt with appropriately by recording warnings and revising the service users contract and individual plan. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,28,30. Allington House provides a safe, homely and comfortable environment for service users. This means that service users can relax and focus on their recovery programme. Service users’ bedrooms were personalised to varying degrees and promoted independence. Communal areas at the home are spacious and well used by the service users and their visitors. The home promotes safe working practices in relation to cleanliness so service users are not at risk from infection. EVIDENCE: Service users at Allington House each have a total average living space of 14.1 sq metres. The inspector conducted a tour of the premises accompanied by the manager who stated that since the last inspection a small lounge area which also Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 21 doubles as a sleep in room, has been decorated. In addition, three bedrooms have been decorated. All bedrooms now have A4 picture boards for service user’s use. The home has a planned programme of decoration and furniture renewal. The home offers a safe, clean and comfortable environment which suits the needs of the client group. Dorset Fire & Rescue Service visited the premises in March 2004 and advice given by them has been acted upon by the manager. The three shared rooms at Allington House have screens offering some degree of privacy. The home’s statement of purpose states the number and size of bedrooms at the home. In accordance with a requirement first made in May 2004, the home now has a suitable shared room policy. Allington House has a front, side and back garden which service users can access. A small pond, pergola and trellis, and a wooden framed shelter to provide a place in which service users can smoke, have recently been added to the garden. There are 2 counselling rooms where service users can have conversations in private and for use for visitors. Communal areas include the dinning room, main lounge and a smaller lounge/sleep in room which has recently been decorated and upgraded so that staff can use it during the day to carry out duties that require privacy or merely to go somewhere quiet. Staff at Allington House have 2 offices. Smoking is not permitted inside the home. The service users at Allington House are expected to participate in the rota systems for cooking, cleaning and washing as part of their treatment programme/stay at the home. There are daily, weekly and monthly cleaning rotas. The inspector found the home to be clean and free from offensive odours. The laundry room was accessed from the corridor and not the kitchen, although there is a door from the kitchen to the laundry area. With the exception of one member of staff, all have received training in infection control. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,34,35,36. Service users are fully aware of staff roles and are supported by a sufficient number of key workers who are suitably trained and qualified offering consistency of care within the home. However, the target of 50 staff with NVQ 2 qualification by 2005 has yet to be met. The recruitment practice of employing ex service users/befrienders/volunteers suits the client group but as the home has adhered to National Minimum Standards service users are protected. The home has a stable staff team who receive support and supervision to ensure that service users’ needs are being met, that appropriate training is undertaken and that whilst working for Streetscene, they have the opportunity for personal development. However, the home has been slow in producing annual staff appraisals. This was first brought to their attention in June 2002. EVIDENCE: Staff spoken with confirmed that they had a clearly defined job description and had a good understanding of their own role and responsibilities. They also confirmed that they received a copy of the home’s written greivance and disciplinary procedures when they were appointed. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 23 Staff were experienced in dealing with the client group and were aware of policies and procedures in place at the home. The inspector witnessed a good rapport between staff and service users and between colleagues. The manager stated that volunteers at the home supplement the work of staff. In accordance with a requirement first made in 2004, volunteers now have job descriptions. Staff at Allington House consists of a manager, 4 counsellors, 1 project worker, 5 night workers, and in the office, a director and 3 financial administrators. In addition, Streetscene have a treatment team co-ordinator who on average, spends two days a week at Allington House. His role is to oversee clinical practice and work with the director in implementing staff training programmes. Between the hours of 9-5, a minimum of 3 staff are on duty, 1 person is on duty between 5-9pm and sleeps overnight. Between 5pm and 9am there is a counsellor on call and extra support from a senior manager on call on a back up rota. Additional support is obtained by 4 volunteers, 6 befrienders and a maximum of 2 Social Work students per year on placement at the home. Befrienders and volunteers are ex-clients of the service who are keen to offer assistance to service users whilst going through/having been through the therapeutic process themselves. Staff rotas were examined by the inspector and found to be sufficiently detailed. Staffing arrangements are made according to the assessed needs of the service users. As a result of the last inspection, a requirement was made for the registered provider to purchase the Residential Forum Calculator from the Social Care Association, and calculate the total number of hours needed in accordance with the assessed dependency levels of service users with the total number of staff hours currently provided at the home. This has been achieved and dependency levels are now calculated in accordance with Department of Health guidance. The manager felt that the staff numbers were sufficient, agency staff were not used and staff turnover and sickness periods were not particularly high. The inspector examined three staff files. The standard of recording has significantly improved with all statutory details in place. The inspector acknowledged the hard work undertaken by the manager to finally meet this standard. Service users are not involved in staff selection as their stay is quite brief, neither are they involved in the review of new appointees. It is considered by management that the process of coming off alcohol/drugs and maintaining a healthy lifestyle whilst being away from family/friends is stressful enough without the additional responsibility of being involved in staff selection. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 24 The home has a dedicated training budget and plan of action for each staff member with regard to training and development. Staff files evidenced this. Currently staff at Allington House undergo an induction process during their first month. The manager Mrs Mills is working towards NVQ 4 qualification. Since the last inspection two members of staff have completed NVQ 3 training and are currently awaiting their certificates. The manager stated that a further two members of staff have started training towards NVQ level 2 and one towards NVQ level 3. The registered provider is reminded to make provision regarding training for NVQ level 2 for 50 of care staff and qualifications must be gained by 2005. Three staff supervision files were examined on this occasion. Specialist supervision takes place once a month when the staff group meet as a team, this supervision examines clinical practice. There has been an improvement in recording since the last inspection and sessions evidenced more detail. The inspector noted that volunteers now receive regular supervision. The manager was advised to include the minimum number of supervision sessions volunteers are expected to have in their contract. Staff appraisals have yet to be completed. The manager stated that she was waiting until all staff had six supervsion sessions before completing annual appraisals as the sessions formed the basis of the appraisal. The manager evidenced that weekly staff meetings have a set agenda and are actioned and recorded. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,42,43. The Manager Mrs Mills has improved the service, facilities and care at Allington House since her appointment as Manager and there was plenty of evidence to support that service users and staff benefit from her style of management. The home regularly reviews aspects of its performance by periodically seeking service users views and acting on them giving service users confidence that they are listened to. The home normally follows practices that promote and safeguard the health, safety and welfare of service users. However, up to date certificates for gas and electricity and content of fire training sessions are required as a result of this inspection. It is clear that investment in the quality of service provision continues to be of paramount importance to the registered provider. Up to date Insurance documentation covers the legal liabilities towards staff, service users and third parties. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 26 EVIDENCE: The manager Mrs Mills stated that she hopes to complete NVQ 4 in Management and Care by the end of 2005. It remains the case that the registered manager must be qualified at level 4 NVQ in both Management and Care by 2005. The home has an internal audit in June each year. An annual report is completed in July, the annual development plan for the home emanates from this report. Service users are involved in the home’s quality assurance system. The registered provider issues client satisfaction surveys to service users every 3 months. A task sheet is attached to ensure that staff action any issues raised and details are fed back to the service user via the notice board in the hallway. The inspector examined the most recent survey which was actioned by the management team details of which were found on the notice board at Allington House. The views of service users and GP’s were sought on this occasion and to date no responses have been returned. Service users spoken with stated that; “Staff were on the ball and act quickly in all situations” “The community meetings are particularly good and let your voice be heard. The staff react within 24 hours”. “We have a good life here, we are respected by staff and other peers and learn the importance of being open and honest”. In relation to Health & Safety at the home, gas and electrical certificates could not be located and copies should be forwarded to the inspector at the Commission for Social Care Inspection office when found. Water temperatures are recorded weekly and as the temperature is around 50 degrees, risk assessments are completed for each service user. Fridge and freezer temperatures are recorded daily. A maintenance record is kept. Portable appliances were tested by a contractor in June 2004. The manager has appropriately reported accidents, injuries, illness or communicable disease or death of a service user at Allington House since the last inspection. The manager stated that all staff receive training in infection control, first aid, moving and handling, health & safety and basic food hygiene. Evidence of this was seen in staff files. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 27 Fire records were examined and found to be satisfactorily maintained with the exception of staff fire training which gave no detail of the content of the training an issue that has been raised with the home on previous occasions. This must be addressed by the registered provider within the time scale stated in this report. A requirement was made as a result of the last inspection for the home to have a business and financial plan available for inspection. It was seen by the inspector on this occasion and found to be comprehensive. Insurance policies regarding building and contents were seen by the inspector and were up to date. Service users at the home are not involved in the business and financial planning and monitoring of the home as management feel it is too much responsibilty for individuals in a recovery programme which in itself is particularly stressful. Staff and service users confirmed that they are informed of the lines of accountability within the home when they first arrive at Allington House. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x 3 x 3 Standard No 11 12 13 14 15 16 17 2 3 3 3 2 3 3 Standard No 31 32 33 34 35 36 Score 3 x 3 3 2 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Allington House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x 2 3 D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 29 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15(2)(b) Requirement The registered provider must ensure that each service users care plan is regularly reviewed and that the review contains detailed information. The registered provider must ensure that service users recreation and social interests are formally addressed. The registered provider must ensure that reference is made to contact with family/friends when completing care plans. Staff must have an annual appraisal with their senior manager to review performance against job descriptions and agree career development plans.Original date for compliance was 05/06/02 The fire training record should give sufficient detail as to the content of the fire training session. Original date for complaince was 31/10/04 Copies of valid Gas and electrical certificates should be forwarded to the Commission for Social Care inspection. Timescale for action 30/09/05 2. 11 16(2)(n) 30/09/05 3. 15 16(2)(m) 30/09/05 4. 36 18(2) 30/09/05 5. 42 23(4) 30/09/05 6. 42 23 31/07/05 Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 35 37 Good Practice Recommendations The registered provider should make provision regarding training for NVQ level 2 for 50 of care staff and qualifications must be gained by 2005. The registered manager must be qualified at level 4 NVQ in both management and care by 2005. Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 31 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole Dorset BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Allington House D55 S3910 Allington House V226920 100505 Stage 4.doc Version 1.30 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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