CARE HOME ADULTS 18-65
Allington House 46 Dean Park Road Bournemouth Dorset BH1 1QA Lead Inspector
Sally Wernick Unannounced Inspection 10:00 17 October 2005
th DS0000003910.V256840.R01.S.doc Version 5.0 Page 1 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 DS0000003910.V256840.R01.S.doc Version 5.0 Page 2 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 Stationery 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. DS0000003910.V256840.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Allington House Address 46 Dean Park Road Bournemouth Dorset BH1 1QA 01202 551254 01202 293660 Telephone number Fax number Email address Provider Web 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 Care Home 16 Category(ies) of Past or present alcohol dependence (16), Past or registration, with number present drug dependence (16) of places DS0000003910.V256840.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th May 2005 Brief Description of the Service: Allington House is a residential unit run by streetscene, a registered charity that operates a total of three residential units, two of which are situated in Dorset the other 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 abide by the treatment philosophy of the house and the necessary restrictions that are imposed. 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 lovely large garden, which this year won 1st place in the Bournemouth in Bloom competition. There is garden furniture and a wooden framed shelter where service users are able to smoke. Volunteers assist in maintaining the pretty grounds and considerable effort is made by staff and the registered manager to create a positive, welcoming environment. DS0000003910.V256840.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and started at 10:00am on 17th October 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 in the inspection. There are currently 14 residents at Allington House. 8 standards were inspected on this occasion. Methodology used included a tour of the premises, review of records and discussions with service users. 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:
Service users spoken to described the home and its staff in glowing terms. There is a very positive ethos at Allington House, which is reinforced and reflected, in an excellent statement of purpose and service user guide. Records indicate that each service user is fully assessed prior to admission and there is good communication with care managers. Expectations of treatment were largely met; clients had access to their files and were involved in the formulation of care plans and reviews. The specific cultural and dietary needs of one resident had been addressed prior to admission and had been met in such a way that allowed him to quickly adapt to his surroundings. Other service users commented that they were involved in the day-to-day running of the home, through residents meetings, meal planning and undertaking domestic chores. Staff at Allington House are well qualified in the field of addictions and this is reflected in qualifications and good working relationships with residents. Service users spoken to confirmed that “staff are good and caring” providing regular key work sessions, and facilitating groups. Staff are regularly supervised and formal appraisals are in place there is an ongoing programme of training to promote individual development. There are clear expectations of both staff and service users and personal responsibility is promoted throughout. The atmosphere is a positive one and
DS0000003910.V256840.R01.S.doc Version 5.0 Page 6 the accommodation is good. Pride is taken in maintaining the grounds and the home is welcoming. The registered manager is keen to promote a very positive ethos and is involved in all aspects of the day-to-day running of the home. What has improved since the last inspection? What they could do better:
Care planning whilst improved lacks details of individual activities and reference to family and friends. One resident felt uncertain about what was contained in his care plan. Care must be taken to ensure that these are reflected accurately and reviewed with service users. A requirement made as a result of the last inspection is repeated on this occasion as it was not met by the due date of 30/09/05 The lifestyle and social interests of service users accommodated at Allington House are varied but limited. Service users spoken to were involved in various activities however, these were not always seen by them as sufficient. There was limited reference to personal interests and care plans did not identify how these might be promoted. The registered provider must ensure that service users recreation and social interests are formally addressed. A further requirement as a result of the last inspection is also repeated.as it was not met by the due date of 30/09/05. The registered provider must ensure that reference is made to contact with family and friends when completing care plans. DS0000003910.V256840.R01.S.doc Version 5.0 Page 7 Whilst it is essential to place a good deal of structure around service users lives whilst in primary treatment. It is equally important that the reasons for this are fully understood and agreement is sought. Allington House provides a service user guide, which details limitations on social activities and contacts. Some choice is offered however; this is not fully recorded on service user files. Service users report that they eat a varied diet however fresh vegetables are not included which suggests meals may not be nutritionally balanced. It is recommended that the registered provider provide fresh vegetables as part of a healthy, balanced diet. It remains the case that 50 of care staff must be qualified at NVQ level 2 by the extended date of 2006. 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. DS0000003910.V256840.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection DS0000003910.V256840.R01.S.doc Version 5.0 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 the following standard(s): Not assessed on this occasion EVIDENCE: DS0000003910.V256840.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 6 Service users spoken with confirmed that they were involved in formulating their care plan to include their identified needs and how their goals and aspirations might be achieved. One service user expressed uncertainty around the content of his care plan, and did not know whether his needs had been assessed correctly or whether these had been accurately reflected. Care plans do not include contact with friends or family. Social aspirations are not outlined fully. EVIDENCE: The inspector examined four care plans all of which were drawn up jointly with the service user. This was confirmed through discussion with those involved the extent to which each individual had engaged with this process however, may relate to the skills of their counsellor. One resident spoken to expressed confusion about his care plan and was concerned that his assessed needs might not be sufficiently outlined or reflected accurately. Each care plan was signed, reviewed and dated and was accompanied by specific weekly progress reports. Treatment goals were identified with a clear
DS0000003910.V256840.R01.S.doc Version 5.0 Page 11 action plan and strategies to enable clients to achieve their personal objectives. Specific health needs were detailed and restrictions from court were clearly recorded. In the case of one resident who had specific cultural needs this was clearly stated. Action had been taken to address dietary and religious requirements prior to his arrival which the service user commented “helped to set me psychologically and I couldn’t ask for more than that ” Plans did not include contact with friends or family and did not reference the social needs and aspirations of each person. Whilst the care plans were informative and contained detailed treatment goals care must be taken to ensure these accurately reflect the needs of the service user. Service users files evidenced that during the first few weeks’ further assessments take place in the form of social, relationship and chemical dependence history. The file also contains a written self-assessment. This information was gathered at different stages by each counsellor. The inspector felt it would be more beneficial to service users if these were time bound as this information can be crucial in accurately assessing the extent of each individuals chemical and emotional dependency. Care plans do detail specialist requirements and planned interventions such as attendance at self help groups. 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 court such as tagging or not being allowed out of the home on their own in the initial phase of their treatment programme. The philosophy at Allington house and their status as a primary treatment provider means that a number of accepted restrictions are imposed. Discussion with service users however, indicates that they are encouraged to make decisions about their lives within those restricted parameters. Service users reported that they felt involved in the day-to-day running of the home and through weekly residents meetings were consulted and included. DS0000003910.V256840.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 11,15,17 Staff promote personal development for service users within the restricted parameters of their treatment programmes. Service users have access to limited activities which are assessed a suitable within their primary treatment programme. Three of the four residents spoken to felt there was insufficient balance between physical activity and group work therapy. Service users do have access to activities to enhance recovery these are not sufficiently detailed in their care plans. Service uses do have contact with family and friend’s limited reference is made to this in care plans. Residents have a healthy diet with a varied menu however, fresh vegetables are not available. DS0000003910.V256840.R01.S.doc Version 5.0 Page 13 EVIDENCE: Allington House is a primary treatment provider and within that context the focus is on recovery from addiction. Activities therefore centre on in-house counselling therapy and support. It is an accepted part of the treatment programmes that in the initial stages service users are accompanied by staff when they go out. Therapeutic group work is intensive and in order to aid recovery service users are expected to attend support groups such as Narcotics Anonymous on an almost daily basis. In addition mini-support groups are formed as and when by residents to offer additional support and address issues of concern. Ex residents also attend and provide input into the therapeutic process. Individual and group work therapy from part of the daily routine at the home and the programme is delivered by competent staff. Once a month a mini-bus is available for outings, which are chosen by service users themselves. One service user said these trips had become predictable and offered little in the way of enjoyment. Another expressed disappointment at the lack of physical activities on offer. Another requested access to Acupuncture, Reiki and other complementary therapies, which are seen as helpful in the treatment of addiction. There is a potential risk of service users re-establishing networks which were previously unhelpful to them. Visitors are not therefore allowed within the initial four-week period. There is also a clear policy on handling mail, which requires service users to open their post in the presence of staff. Service users spoken to said they had benefited enormously from the group work, learning about themselves and their addictions. The concept of cross addiction (moving from one substance to another) is also addressed at Allington and for this reason attendance at all support groups is required. Comments received were that groups were “well-structured”, “boosting morale, big-time” expectations had been met following the pre-and initial assessments and one service user stated he “wasn’t disappointed at all”. Another comment received was that “staff go to any lengths to make us feel special”. All of the service users spoken to were happy with the therapeutic input. Three of the four however, were unhappy at the lack of activities on offer although again this has to be seen within the context of a primary treatment facility. Hobbies and interests whilst playing a role in self-worth may be addiction related and inappropriate. Any activities therefore are fully assessed by staff to ensure they do not interfere with the treatment process. DS0000003910.V256840.R01.S.doc Version 5.0 Page 14 Whilst it is essential to place a good deal of structure around service users lives it is equally important that the reasons for this are fully understood and agreement is sought. Allington House provides a service user guide, which details limitations on social activities. Some choice is offered however; this is not fully recorded on service users files. Following the initial four-week period visitors are permitted at Allington house. Service users choose the level of involvement, which they want from friends and family and privacy, is respected. Although the inspector was able to find reference to personal relationships in service users individual plans the information was limited and did not offer links with the therapeutic process. For those service users moving on to independence, relationships may need to be re-established on a different basis to the one held prior to treatment. This information was not recorded. Service uses spoken to stated that they benefited from varied menus and a healthy diet. However, fresh vegetables are not provided which suggests meals may not be nutritionally balanced. Cultural preferences are taken into consideration both pre-and on admission. One service user eats only Halal meat this was provided and every care was taken to ensure that his needs could be fully met. DS0000003910.V256840.R01.S.doc Version 5.0 Page 15 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 the following standard(s): Not assessed on this occasion EVIDENCE: DS0000003910.V256840.R01.S.doc Version 5.0 Page 16 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 the following standard(s): Not assessed on this occasion. EVIDENCE: DS0000003910.V256840.R01.S.doc Version 5.0 Page 17 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 the following standard(s): Not assessed on this occasion. EVIDENCE: DS0000003910.V256840.R01.S.doc Version 5.0 Page 18 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35,36 Staff are well qualified to work in the area of treatment and addictions. However, the target of 50 staff with NVQ qualification by 2005 has yet to be met. Staff receive monthly and bi-monthly supervision. Appraisals are yearly and focus on staff achievement, training and development. EVIDENCE: Staff at Allington House hold a range of relevant qualifications, which makes them well qualified to work in the area of treatment and addictions. Two project workers currently hold NVQ 3 and all counsellors hold relevant diplomas and certificates. There are clearly defined job descriptions and all staff attends appropriate training for example in Health and Safety and medication handling. However, the registered provider is reminded to make provision regarding training for NVQ level 2 for all care staff and qualifications must be gained by 2006. Residents report that staff are well qualified in the treatment of addictions, assisting residents to identify what they want from treatment, helping to formulate clear goals and agreeing interventions. One comment received was that “staff understand and know what their doing”.
DS0000003910.V256840.R01.S.doc Version 5.0 Page 19 Two staff files were examined. There was evidence that staff receive formal bimonthly supervision with the registered manager. The inspector was informed that all staff receive clinical supervision with an external counsellor monthly. The registered manager is currently undertaking a course in staff supervision and has made great efforts to improve methods of recording. One appraisal had been completed for one staff member an identified date for appraisal had been set for another. Performance objectives are set. Future objectives, career developments and training needs recorded. Staff files and reports from service uses indicate that staff were very experienced in dealing with the client group, and were well qualified to do so. The registered manager Mrs Mills has made considerable efforts to improve standards of recording and to implement supervision and appraisal for all staff. The positive ethos within the home and the home’s philosophy is reinforced by her caring attitude to residents and staff and by her commitment to training and development both her own and others. DS0000003910.V256840.R01.S.doc Version 5.0 Page 20 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,42, Mrs Mills the registered manager is qualified in NVQ 4 The commission has received up to date certificates confirming gas and electricity units have been serviced. The contents of staff fire training have been recorded and made available for the inspection. EVIDENCE: Since the last inspection Mrs Mills the registered manager has completed her NVQ4. She has attended relevant training to ensure her own continued development and is able to meet the necessary requirements Following the last inspection gas and electrical certificates could not be located these have now been forwarded to the Commission and confirm that servicing has been undertaken by appropriate contractors. DS0000003910.V256840.R01.S.doc Version 5.0 Page 21 The inspector viewed the fire training record. Mrs Mills confirmed that staff undertake four fire-training events each year the content of which is now recorded and signed for meeting the requirement from the last inspection. The last fire training session had been completed in July of this year and included a DVD followed by a staff quiz. Any new member of staff is required to undergo fire training on their first day which was confirmed in the records of a new volunteer. The registered manager Mrs Mills stated that all staff receives training in infection control, first aid, moving and handling, health and safety and basic food hygiene. Evidence of this was seen in staff files. DS0000003910.V256840.R01.S.doc Version 5.0 Page 22 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 x x x x x
x Standard No 22 23 Score X x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x x x Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 2 12 X 13 X 14 X 15 2 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 4 x CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 3 x DS0000003910.V256840.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes 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. Standard Regulation Requirement The registered provider must ensure that each service user is fully involved in the drawing up and reviewing of the individual care plan. The registered provider must ensure that service users recreation and social interests are formally addressed. Original date for compliance was 30/09/05. The registered provider must ensure that reference is made to contact with family/friends when completing care plans. Original date for compliance was 30/09/05. Timescale for action 31/01/06 1 OP6 15(2)(c) 2 OP11 16(2)(n) 31/01/06 3 OP15 16(2)(m) 31/01/06 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 OP17 OP35 Good Practice Recommendations The registered provider should consider providing fresh vegetable as part of a healthy balanced diet. The registered provider should make provision regarding training for NVQ level 2 for 50 of care staff and qualifications must be gained by 2006.
DS0000003910.V256840.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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