Inspection on 14/11/07 for ANA Treatment Centre

This inspection was carried out on 14th November 2007.

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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

ANA Treatment Centre 13/11/08

Similar services:

Flint House

The Ley Community

Yeldall Manor

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

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

CARE HOME ADULTS 18-65 ANA Treatment Centre Waterworks Road Farlington Portsmouth Hampshire PO6 1NJ Lead Inspector Neil Kingman Key Unannounced Inspection 14 November 2007 10:00 ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 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 ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 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. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service ANA Treatment Centre Address Waterworks Road Farlington Portsmouth Hampshire PO6 1NJ 02392 373433 02392 373434 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) ANA Treatment Centres Ltd Janette Coulson Care Home 29 Category(ies) of Past or present alcohol dependence (29), Past or registration, with number present drug dependence (29), Mental disorder, of places excluding learning disability or dementia (29) ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Past or present drug problem - D Past or present alcohol problem - A Mental disorder, excluding learning disability or dementia – MD 2. The maximum number of service users to be accommodated is 29. Date of last inspection New service Brief Description of the Service: ANA Treatment Centre is a residential treatment centre for drug and alcohol addiction. It is registered as a Care Home providing support and accommodation for up to 29 service users. The service is located in a residential area of Farlington about two miles to the northwest of Portsmouth city. The property is a large two storey detached building with accommodation arranged over two floors, all but two of the rooms being for single occupancy. Communal areas comprise a large main lounge a quiet lounge that can also be used for meetings, two small group rooms and a dining room. There are bath/shower rooms and toilets on both floors. Outside at the rear is a large enclosed garden laid to lawn with fruit trees. There is a patio area and seating available to those who use the service. Off road parking is available at the side of the building. The service provides a rehabilitation programme, which is highly structured and includes various restrictions on peoples’ freedoms. The manager states that weekly fees range from £450 and £550. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the results of an evaluation of the quality of the service provided by ANA Treatment Centre and brings together accumulated evidence of activity at the Centre since it was first registered on 16 May 2007. Part of the process has been to consult with people who use the service. To this end we have received written responses to several surveys, i.e., eleven from people who live in the home, thirteen from staff members and one from a visiting healthcare professional. Included in this inspection was an unannounced site visit to the home by an inspector on 14 November 2007. The registered manager Ms Coulson was available throughout the day. At the visit we had an opportunity to speak with staff on duty, and several service users. We also toured the building and looked at a selection of records. Prior to the site visit the manager sent to the Commission a range of information about the service including an Annual Quality Assurance Assessment (referred to as the ‘assessment’ during the report), which has been used with other information to inform the various judgements made about the service. What the service does well: An opportunity for the home to tell us how well it is delivering good outcomes for the people using the service was the assessment forwarded to the Commission as part of the inspection process. Extracts from the assessment have been included in the various outcome groups throughout the report. There was evidence from our observations during the site visit and from comments received that ANA delivers a service that supports people to lead healthy, productive lives, free from reliance on drugs and alcohol. Some comments in the service users survey highlight the work they do: • • • • • • • • • • • “ANA is a good place and it has helped me a lot.” “I am happy here.” “Staff are good listeners.” “Excellent support from staff and peers.” “Very good structure.” “High level of support for individual’s needs.” “Excellent in their jobs and very caring for the clients.” “They are always there.” “They are very open and responsive and I feel I can trust them.” “They react to my needs appropriately.” “They are professional, caring, efficient and knowledgeable in their field.” DS0000069835.V349802.R01.S.doc Version 5.2 Page 6 ANA Treatment Centre One service user we spoke with during the site visit was very positive, praising the Centre for giving him the support to enable him to lead a productive life when he leaves. This was reflected in the view of all those spoken with. Special mention was made of the counsellors and key workers who were seen to be skilled and dedicated. Staff spoken with showed a commitment to providing the best possible service. What has improved since the last inspection? What they could do better: It can be seen from the report that the service has more strengths than weaknesses. However, the one area of weakness that is identified as having poor outcomes for people who use the service is the vetting of new care staff. Services must have a robust system, which ensures all newly appointed staff have been security checked to an acceptable level before they commence working in the home. Anything less places vulnerable people at risk of abuse. All staff must have a Criminal Record Bureau check and newly appointed staff must have at least POVA First clearance before they commence working in the home. It is recognised that given the nature of the service provided at the Centre and the advantages of recruiting staff who have previously been through the treatment programme, applicants may not be able to call upon employment references. However, it is important in such circumstances that the home obtains character references for these people. While the home understands the need to comply with the regulations relating to the administration, safekeeping and disposal of medicines there were identified areas that could be improved. Shortfalls were noted in the arrangements for recording and disposal of medicines. The manager was able to confirm that staff receive training in the safeguarding of adults from abuse. However there were no records available to evidence this. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 7 Two areas were identified where good practice could be improved: • • To confirm with Skills for Care the appropriateness of the current staff induction programme. To increase the programme of formal staff supervision to six times a year. 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. The summary of this inspection report can be made available in other formats on request. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 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 ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service have the information needed to choose a service that will meet their needs. The manager ensures that the support needs of the people who use the service will be met by undertaking a proper assessment prior to them moving into the Centre. EVIDENCE: Information – The service has produced a combined Statement of Purpose and Client’s Handbook, which is given to all service users before they move into the Centre. The manager explained that in practice due to the fact that many of the referrals come through care management the care managers have copies of the handbook included in an information pack, which they make available to people when ANA is being considered. The handbook gives the person an idea of what to expect at ANA. It sets out ANA’s vision and values and describes the restrictive boundaries that people are expected to adhere to. It contains a Client Charter that people are expected to sign up to before they begin the treatment. The handbook gives ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 10 detailed information about all aspects of the service and covers the areas of confidentiality, diversity and equality. Nine of the eleven responses to the service users survey indicated they received enough information about the Centre before they moved in. Pre-admission assessment – People should know that their needs will be met when they consider using a service. An important part of ensuring this happens is the pre-admission assessment process. The manager described the admissions process in general, and specifically in relation to the newest person to be admitted for treatment: • • The service has an admissions team responsible for carrying out all aspects of the process. They use a pre-admission assessment tool, copies of which were noted on the files seen during the site visit. Typically referrals come through the Criminal Justice System or by way of the public health route, where a Care Manager is familiar with the service that ANA can provide. Care Managers are provided with an information pack giving detailed information about the service and facilities, which can be faxed or e-mailed to them. The manager confirmed that a person-to-person assessment is preferable but not always possible, as was the case with the person most recently admitted. This individual who came to the Centre via the criminal justice system was admitted just a few days before our site visit. A computerised care plan was in place with an assessment and risk assessment. Care managers’ assessments are forwarded to ANA before the client is admitted, and form the basis of their treatment plan. • • • Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • Very clear and detailed statement of purpose and client handbook. Detailed assessments are made prior to referral to ANA by DAT Care Managers. These are forwarded to us prior to our assessment with the prospective client. We undertake our own assessment, cross referencing to the care managers assessment and consequently reducing the impact of multiple repetative questions on clients who are, often very unwell upon referral and admission. Our assessment documentation is clear, unambiguous and linked to Hants, approved Common Assessment Tool (CAT). There are no unplanned admissions at ANA - we are not an open access service. Clients visit for in-person assessments accompanied by family DS0000069835.V349802.R01.S.doc Version 5.2 Page 11 • ANA Treatment Centre • members and or care managers - these occur frequently and prospective clients are enjouraged to tour the facilities and spend time with the current client group before making their decisions. There is now a far more structured approach to assessment and visits, paper work and process standardised and improved. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the support they receive as part of the therapeutic regime. EVIDENCE: Personal plans, decision making and risk taking – Each person who uses the service has the overriding goal of becoming free from drugs and mind changing substances through the ‘twelve steps’ and behavioural counselling. They each have a personal plan, which is developed around this goal. We looked at a sample of three plans, one for the newest resident, one for a person coming towards the end of their residency and one for a person who has presented with challenging behaviour. The intention was to look at the outcomes for people in general by assessing all areas of support for those sampled. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 13 There are four counsellors on site assigned to individuals throughout their stay at the Centre. This is to ensure consistency. In addition, each individual has a key worker. We spoke at length with one of the counsellors who had first hand knowledge of the planning system and was able to describe the process, particularly in relation to those sampled. The first thing included in the plan is a risk assessment, which is based on the information obtained before the person is admitted. Plans are computerised and updated daily by the counsellors. They were seen to contain a basic plan of care/support, a warning log, a behavioural contract and daily notes. Periodic summaries contain specific and detailed information concerning the individual’s progress throughout the treatment programme. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • • • • • Care plans are written with clients and reviewed on a continuous basis. Care plans are informed by daily client notes. External agencies such as probation, social services, district nursing are all involved where appropriate. Client choice is paramount and recorded. ANA has a dedicated benefits officer to deal with DWP procedures. Client reviews are now held weekly, as is Community Group. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While there are restrictions on peoples’ rights it is part of the therapeutic regime where the primary aim is to recover from addiction. People are supported to develop their life skills in the second stage of treatment. EVIDENCE: Education and occupation – In the early stages of treatment the obtaining of employment is not relevant as the primary aim is to recover from addiction. However, when service users approach the second stage treatment they are introduced to an educational workshop, e.g., art work, computer course, etc., which are provided by ‘Learning Links’. If employment is not forthcoming a further plan is drawn up, which is less therapeutic and more specifically aimed at developing links within the community, with an emphasis on promoting autonomy and independence. It was explained in discussions with staff that at this stage they ensure that ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 15 multi-agency links are strong and the police, probation and religious leaders are all involved in providing support for people in various forms. Community links, social inclusion and relationshipsA key aim of treatment is to re-integrate service users into the community and the first stage of the programme is residential. In the first few weeks following admission to the Centre the primary activity is the participation in the structured treatment programme. There are restrictions imposed that limit service users’ links with the community early in the treatment programme and they sign up to these in the Client Charter. Restrictions are relaxed from the seventh week onwards, e.g., receiving visitors and the use of the telephone. Towards the end of the first stage service users are allowed access to the community with support and a range of leisure activities has been introduced to provide interest and entertainment. The last three weeks of the first stage are a transitional mix of residential and non-residential activities involving outside groups preparing service users for independent living. Intimate personal relationships are discouraged and are included in the rules of the house. The manager confirmed that the service regards the safety of vulnerable females and males as paramount. In the service users survey there were mixed messages about their being able to make decisions about what they do each day: five indicated sometimes, two always, two usually and two never. Specific comments talk about all groups being organised, decisions being down to counsellors, support from staff and peers, structured and planned group work. In discussions with the manager and one of the counsellors the comments reflect the structured approach to the programme where restrictions are a necessary and vital part of treatment. Daily routines – The service users publish a rota of daily routines in the dining room. It involves a rolling routine of identified tasks, times to carry them out and by whom. Peer pressure ensures that the nominated individuals complete these tasks, which, according to staff spoken with promotes accountability and works quite well. The service has a clear policy on room searches, which in practice are rarely carried out. The Centre’s aim is to promote trust and searches only take place where there is a specific suspicion that addictive substances may be present in the room. They are undertaken by two members of staff in the presence of the service user and are separate from room checks that are carried out daily. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 16 Meals – The service users’ handbook states that nutrition and healthy eating are important aspects of recovery and people receive a healthy balanced diet. Service users are supported to develop their cooking skills and knowledge of nutrition as part of their life skills programme. Service users typically prepare their own breakfast and receive a packed lunch. There is a hot meal provided in the evening. Menus showed food to be varied and nutritional, with fresh fruit and vegetables readily available. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • Development of emotional skills is central to the therapeutic programme, taking responsibility for self, recognising consequences of previous (using) and current (abstinent) behaviour. Applying what is learnt to life in the ANA community with support from staff and peers. Formal education, community involvement and freedom of movement is limited in Primary Treatment due to focus on recovery from drug, alcohol and gambling addiction. The range of appropriate leisure activities has been considerably extended in the last year to include visits to places of interest, sporting activities (football, table tennis, badmington, volley ball) art workshops, longe-based games, relaxation and meditation. Family links and visits are maintained within specified boundaries throughout treatment. The menus have been extended to include up to five daily choices of evening meal, reflecting lifestyle, cultural and relgious preferences. All requests for specific meals are accommodated. • • • • ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 - People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and support that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Anomalies found with medication practices need to be addressed to ensure the safety of service users. EVIDENCE: Personal support – Service users are able to support themselves and need no technical aids, adaptations or equipment. As previously described the service operates a timetable, which includes getting up/mealtimes etc. Flexibility is not usually regarded as helpful as the re-establishment of routines in a person’s life is essential for recovery. Healthcare – ANA has an arrangement with a contracted GP who has specialist knowledge of substance misuse. The GP makes regular on-site visits, one of which happened to be during our inspection. All healthcare checks are routinely ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 18 carried out on site although they can take place at the surgery where appropriate. All healthcare issues are dealt with immediately as and when they occur. The response to the health professionals survey indicated that individuals’ health care needs are usually met by the service, and the service always responds to the different needs of individuals. However, it was felt that relations and communication with the local GP practice could be improved. A positive comment was that, “ ANA allows drug and alcohol users to see, understand and accept their illness and their part in it, and offers hope that there is a better way, a way out – it is such an inspiring place.” Medication Service users often enter residential treatment having a history of chaotic administration of often illegal substances. Therefore ANA considers it is not good practice for service users to control or administer their own medication during stage one of the treatment programme. We looked at the home’s arrangements for service users’ medication with the manager and the following issues were identified: • A discussion was held about the security of medicines within the locked room, which has a small window making the contents visible from the outside. A risk assessment needs to be carried out in this respect as in terms of good practice it may be necessary to obscure the window. The service has a policy and procedure for the administration of medicines to service users. However it needs updating to eliminate the instruction that, “All medicines are dispensed by the nurse.” There were a number of anomalies with the recording of medicines, which were pointed out to the manager at the time. Medication in respect of three service users had information on the original containers that was not reflected on the Medicines Administration Record. Changes authorised by the GP must be clearly recorded and signed by the GP. Old stocks of medication must be returned to the pharmacy against signature. • • • Records showed that medication is administered by staff who have been trained in medicines management and deemed competent by the manager. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 19 Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • Within the boundaries of being a treatment centre for addictions, ANA does all it can to to maximise clients privacy, dignity, independence and involvement in decision making. Through partnerships with our contracted G.P.s, local surgery and community services, we ensure that Clients are supported to begin to take control of their own healthcare needs. This is all part of treatment, life skills and recovery from addiction. Health is monitored on a daily basis with on site GP surgery once a week. ANA facilitates visits to health care providers in accordance with clients care plans and presenting needs. Due to the risks involved in allowing addicts to administer their own medication, this is not allowed at ANA. Adherance to medical protocols is paramount at ANA and training for staff is continuous. We have introduced fully compliant meds policy, procedures and protocols, linked to external training provision and approved by CSCI pharmaceutical inspector following her initial assessment visit. We have developed excellent working relationships with local surgery where clients are registered during their time at ANA. We are now able to escort clients to health related meetings, wait for them (and maintain their privacy) and then return with them. • • • • • ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 - People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse. However, safeguarding of adults training needs to be formalised and documented. EVIDENCE: Complaints The homes pre-inspection information indicated that there had been no complaints about this service since the date of registration. The home’s complaints procedure is set out in the client’s handbook and charter. There are several situations where they have opportunities to raise any concerns, e.g., one-to-one approaches to staff or the manager, and the regular formal meetings with the allocated key worker. Ten of the eleven responses to the service users survey indicated they knew who to speak to if they were not happy. All indicated they knew how to make a complaint. There were mixed messages about whether staff listened and acted on what they say. Six indicated always, three usually, one sometimes and one never. However, in discussions with service users and staff it appeared to relate to their treatment programmes. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 21 Safeguarding adults – Information provided as part of the home’s assessment indicated that policies, procedures and codes of practice are in place in the area of safeguarding adults and the prevention of abuse. We looked at the policy during the site visit and noted it followed Local Authority procedures as regarding reporting issues of concern. Staff spoken with were unable to confirm that they had received training in safeguarding adults. However, they were very clear about the importance of reporting issues of concern without delay. The manager stated that safeguarding awareness training does take place. However, it needs to be formalised and documented. The home provides a secure system of safeguarding service users’ monies. The arrangements were fully explored and judged to be appropriate. In a dip sample of records entries were found to be accurate, monies balanced and receipts were kept of incidental purchases. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • Complaints procedure in place and easy to understand by both staff and clients. It is linked to the Client Handbook and Client Charter and contains very detailed timescales. ANA also has in place clearly explained policies and procedures, explicitly linked to QUADS standards and benchmarked against local agency procedures that protect clients from abuse, neglect and self harm. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 - People who use the 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’s premises are suitable for its stated purpose. They are reasonably comfortable, safe and well maintained. On the day of the site visit the home was clean, hygienic and free from unpleasant odours. EVIDENCE: Premises – ANA Treatment Centre is a large two-storey property located in a residential area of Farlington on the outskirts of Portsmouth and offers the service users a safe and reasonably comfortable home. The building is suitable for people who are independently mobile and all areas including the garden are accessible. During the site visit we toured the building with the manager. It was noted that bedrooms contained a bed, bedside table with lamp, storage space, ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 23 adequate seating, a desk to sit at, and a wash hand basin with mirror above. They are reasonably well decorated and equipped. The home provides communal shared space comprising a large well-furnished and comfortable lounge, a quiet lounge that can also be used for meetings, two small group rooms and a dining room. There are adequate shower and toilet facilities on both floors. Outside the large enclosed garden is mainly laid to lawn, with fruit trees. A patio, which can be accessed via sliding doors from the lounge, has seating for use by the service users and staff. Cleanliness During the site visit all areas were noted to be clean and free from unpleasant odours. There is a laundry room on both floors, sited away from areas where food is prepared, cooked or eaten and equipped with commercial grade machines. These are used by the service users to carry out their own laundry. All communal toilets and bath/shower rooms used by the service users are equipped with liquid soaps and disposable towels. The manager agreed to extend this to the staff toilet/bathroom where cloth towels and a soap bar were evident. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does well in this area: • • • • • • ANA relocated to a brand new treatment facility in January 2007 and achieved registration with CSCI in May 2007. All of our efforts prior to these two dates were aimed at improving the clients living, treatment, leisure and catering enivonments. Our new premises is fully refurbished to national standards of equipment, health and hygiene. New facility (Fleming House) is maintained on an ongoing basis. The facility is light and bright, modern and homely. Feedback from all visitors including other agencies, clients, and family members supports this. Health and hygiene is maintained to national standards and policies are inplace to support this. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 - People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and are deployed in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. However, shortfalls in the home’s recruitment procedures have the potential to put people at risk of abuse. EVIDENCE: Staff Team – The Centre employs mixed gender full and part time staff including counsellors and support workers. In addition to the Registered Manager there are two Directors, a Programme Manager (therapeutic), a Financial Controller and an Admissions Officer. There are additional cleaning and catering staff, and contracted grounds and building maintenance staff. The manager and staff spoken with felt there was a need for additional staff as it had proved difficult to cover holidays and sickness. The manager said that two new staff had been recruited and others would follow. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 25 Staff recruitment The manager confirmed that all but two newly recruited staff had worked at the Centre well before the service was registered and that staff turnover was low. The service has a recruitment procedure that includes: • • • • • • • Application form Contract of employment Confirmation of fitness to work Proof of identification Employment history Job description Criminal record and Protection of Vulnerable Adults (POVA) checks We looked at the recruitment files for the two newly recruited staff and three randomly selected long term staff and noted that no written references were included. The manager said that given the nature of the service provided at the centre and the advantages of recruiting staff who had previously been through the treatment programme, applicants were rarely able to call upon employment references. While such difficulties are recognised Schedule 2 to the Care Homes Regulations is quite specific about the information required to be kept in respect of people working in the home. It is important therefore that steps are taken to obtain character references for all newly recruited staff. For existing staff, a risk assessment must be produced in respect of each individual who does not have references on file. This would provide confirmation that the registered person considers those without references are safe to work with vulnerable adults. It was also noted that the two most recently recruited staff had commenced working at the centre before Protection of Vulnerable Adults (POVA) clearance had been obtained. This practice has the potential to put people at risk. Ten of the thirteen responses to the care staff survey indicated the employer carried out CRB and reference checks before they started work, and three indicated they did not. Staff training, development and competencies The management have produced a training plan, which shows at a glance the position with regard to staff training. The plan, which covers ongoing training, training needs and planned training includes some mandatory, professional and service specific subjects. However, it does not include such mandatory subjects as health and safety and fire training. The manager was very clear that these subjects are covered in induction training for new staff. This needs to be formalised and documented in respect of all staff. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 26 Records demonstrate that the service specific training provided for staff includes: • • • • • • • • Sex addiction and therapy Understanding mental health Counselling skills Medicines management Equality and diversity Alcohol dependency Cocaine awareness Lone worker training We also viewed a random selection of qualification certificates in staff files that evidenced the training given. Records showed that ten of the sixteen staff have achieved the National Vocational Qualification (NVQ) at level 2 or above, two are working towards qualification and one has enrolled on the next training programme. The manager described the induction programme for new staff, which is tailored to the kind of support they are expected to provide, with an emphasis on boundaries and protocols. It does not follow the ‘Common Induction Standards’ recommended by Skills for Care. It is recommended that contact be made with Skills for Care to confirm the appropriateness of the current staff induction programme. There were mixed messages about induction training in the responses to the staff survey. Four indicated their induction covered everything they needed to know to do the job very well when they started, seven indicated mostly, one partly and one not at all. Supervision and support – It was clear from records and discussions with the management, staff and the results of the staff survey (detailed under the management heading) that formal one–to–one supervision takes place. However, there was common agreement that it is not frequent enough to meet the minimum standard of six times a year. The manager explained that, as the service was newly registered the focus had been directed at other areas, and staff supervision had been less of a priority. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 27 Provider’s Annual Quality Assurance Assessment The assessment identified what the service does well in this area: • • • • • • • • All job descriptions are in place and agreed with staff, linked to performance development review system (supervision) which occurs quarterly. Roles and responsibilities are clearly defined and understood, reinforced by policy and procedure, training, shadowing and one to one feedback. Training plan for year and future training / accreditation plans are in place. NVQ training beginning for those not already qualified to this level. Induction plans. Impact of clinical supervision on therapy team - very positive. Structured bespoke training events now delivered by external providers, on site at Fleming House. Now we have the facility to provide this training, this approach has helped to maximise relevance and attendance. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 - People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from living in a home that is generally well managed. Quality assurance measures are in place to ensure the home is run in peoples’ best interests, and the home’s policies, procedures and staff training ensure as far as is reasonably practicable, peoples’ health and safety. However, while the manager is aware of the need to promote safeguarding, there is a need to make recruitment procedures more robust to protect service users. EVIDENCE: Management – The service has a registered manager and a management team. The manager is a Registered General Nurse (RGN) and has two years experience of working within a drugs and alcohol service. She is currently training for the Registered Managers Award (RMA). ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 29 It was clear from observations during the site visit that the management team interact well with the support workers, counsellors and the service users. Communication was seen to be good. During the day service users were coming to management with problems and dilemmas, which were dealt with effectively as they arose. The manager completed the home’s Annual Quality Assurance Assessment clearly and fully, and returned it to the Commission promptly. As described earlier in the report shortfalls in recruitment procedures need to be addressed to better protect the service users. There were mixed responses in the staff survey to the question of whether the manager gives them support and discusses how they are working. Five indicated often, three regularly, three sometimes and two never. The same applied to the question as to whether staff felt they had the right support, experience and knowledge to meet the needs of people who use the service. Nine indicated usually, one always, one sometimes and one never. Quality assurance – The home’s assessment indicates that an annual development plan for quality assurance is in place. A ‘reflections’ book is kept for informal observations of the service users when they move on from the home. The questionnaire covers their views on how they feel, programme content, staff, food, facilities and recreation. Other areas that inform the home’s quality assurance are: • • • Staff meetings and supervision sessions. Care plan reviews. The success rate of service users through the programme. Health and safety The home’s pre-inspection information confirmed that policies and procedures were in place to ensure safe working practices in the home. During the site visit the health and safety manager produced a comprehensive file, which contained details of health and safety checks, certificates showing regular servicing of the gas and electrical systems, fire safety equipment, fire alarm tests, and the Control Of Substances Hazardous to Health (COSHH) sheets. The manager confirmed that staff receive statutory training in fire and health and safety. However, as mentioned earlier in the report this needs to be documented. Identified staff have certificated training in first aid. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 30 Provider’s Annual Quality Assurance Assessment The assessment identified what the service does well in this area: • • • • The Manager is a qualified Nurse and is currently working towards her RMA. All the managers and Directors are qualified in their fields of responsibility. Management practices are in accordance with policy and procedure. Staff and management work well together and there is a positive atmosphere in the working environment. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 31 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 Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x x 3 x ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? N/A 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 YA20 Regulation 13 • Requirement Timescale for action • • • To carry out a risk assessment to confirm that 14/12/07 storage of medicines is secure. To update the medicines policy and procedure to eliminate the instruction that, “All medicines are dispensed by the nurse.” Changes in the administration of medicines authorised by the GP must be clearly recorded and signed by the GP. Old stocks of medication must be returned to the pharmacy against signature. 14/12/07 2 YA23 13 To ensure that staff training records evidence the fact that they receive training in the safeguarding of adults from abuse. • 3 YA34 19 To ensure service users 14/12/07 are safeguarded POVA First checks must be obtained in respect of all employees Version 5.2 Page 33 ANA Treatment Centre DS0000069835.V349802.R01.S.doc • • before they start working in the home and having access to the people who use the service. A minimum of 2 written references must be taken up on all newly recruited staff. Where professional references are not available, character references must be obtained. For existing staff, a risk assessment must be produced in respect of each individual who does not have references on file. 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 YA35 YA36 Good Practice Recommendations To confirm with Skills for Care the appropriateness of the current staff induction programme. To increase the programme of formal staff supervision to six times a year. ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 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 © 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 ANA Treatment Centre DS0000069835.V349802.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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