Inspection on 06/01/06 for Broadreach

This inspection was carried out on 6th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Broadreach 25/10/07

Broadreach 05/07/06

Broadreach 26/01/05

Broadreach 10/06/04

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 Broadreach 465 Tavistock Road Roborough Plymouth Devon PL6 7HE Lead Inspector Fiona Cartlidge Unannounced Inspection 6th January 2006 11:30 Broadreach DS0000003576.V262080.R02.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 Broadreach DS0000003576.V262080.R02.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. Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Broadreach Address 465 Tavistock Road Roborough Plymouth Devon PL6 7HE 01752 790000 01752 785750 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) Broadreach House Caroline Jane Pulley Care Home 36 Category(ies) of Past or present alcohol dependence (36), Past or registration, with number present drug dependence (36) of places Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered as a Care Home with Nursing for a maximum of 36 Service Users in the categories past or present alcohol dependence 36 past or present drug dependence 36 6th July 2005 Date of last inspection Brief Description of the Service: Broadreach House is a registered charity providing a range of services in Plymouth, Devon, for the treatment of alcohol and drug dependence. Broadreach is a 36 bedded registered nursing facility for ‘first stage’ treatment for drug and alcohol dependence, for males and females over 18 and up to the age of 65; the normal length of stay is 6 weeks. The house is on the outskirts of Plymouth and is arranged on two floors with access to most parts of the building for Service Users. Most of the accommodation is in shared rooms. There is a variety of bath and shower rooms and WC’s. There is a dining room, a lounge where smoking is permitted and a further smaller lounge/meeting room. There are several private rooms/offices, on the ground floor, used for one to one counselling. The home benefits from well laid out gardens to the front and side of the house where outdoor activities take place in good weather. The home employs 24 hour trained nurse cover, counsellors and other support staff to maintain the programmes of care designed for the Service Users. Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5 and half hours and was in response to the Commission receiving an anonymous complaint about staffing levels in the nursing department, security and safety of residents and staff. The inspector found that a number of the concerns communicated to the Commission had been raised with management in the home and an internal investigation and audit of some issues had been undertaken and reported on. This was the homes second inspection of the year and not all standards were assessed on this occasion, readers will need to consider the content of the last report dated July 2005 to gain a full picture of how the home has been measured against key National Minimum Standards. The inspector spent time talking to members of the management, counselling and nursing staff and reviewing documentation in relation to policies, procedures and communication systems as well as looking at the personnel file of 1 member of staff. What the service does well: What has improved since the last inspection? What they could do better: Open formal and informal communication systems between the management team and all staff should be put in place to allow people to express their views and to affect the way the service is delivered regularly. Environmental risk assessments should be performed and appropriate action taken to negate the risks posed through doors to the exterior of the building being left open. The staff file seen indicated that the recruitment processes are not consistent. To ensure that all staff are suitable to care for the needs of the clients the recruitment process must be improved to ensure all information required is obtained before an offer of employment is made. All staff should receive regular support, formal supervision and opportunities for developing their skills to ensure they have the specialist knowledge and skills to meet the needs of the clients at all times. Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 6 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. Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 7 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 Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 8 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): 0 None of these standards were assessed on this occasion. EVIDENCE: Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 9 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): 10 The information held about clients is handled appropriately and confidentiality is respected. EVIDENCE: The inspector examined the policy and procedural documents held in the home - a clear policy on document management and confidentiality was included in the manual. A Personnel file seen during the inspection provided evidence that staff are aware of the policy and sign a confidentiality agreement following their employment. Observed verbal interaction between clients and staff supported the homes approach to confidentiality with clients feeling able to share personal information in an open and supported manner. Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 10 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): 14 Leisure activities meet the needs of clients on weekdays but appear not to do so at weekends. EVIDENCE: Clients are admitted to Broadreach for a six - week period of detoxification and rehabilitation from addictive substances, so some of these standards do not apply. As part of the programmes during the week, clients have to take part in a structured day, attending groups and counselling sessions. During the evenings a range of alternative activities are offered, these again mainly relate to the therapeutic approach of the home. Clients cannot go out of the home unattended by staff until they have been under treatment for a set period of time and visitors are only allowed by appointment. Nursing staff said that demands on their time and skills increased at weekends because there is less organised therapeutic activity, it should be understood that this free time is an integral part of the therapeutic programme. The homes clients are supported in developing their coping skills when faced with inactivity and the nurses and councillor on duty should play a key part in supporting this at weekends and during the evening. At the time of the inspection (a Friday) a number of videos Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 11 where left in the nursing office for use over the weekend these videos had been chosen by the clients from a list that is circulated within the home. A group of clients were also seen returning from a sports centre where following medical advice they are able to access the swimming pool and gym facilities. Clients are expected to take responsibility for their own lives and how they affect others, as part of the programme. Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 12 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): 20 Staff do not appear to follow therapeutic drug regimes at prescribed times this could impact on the overall success of the clients treatment programme. EVIDENCE: Clients at Broadreach do not generally need support in meeting their physical care needs, however they do need support in changing their pattern of lives away from a reliance on addictive substances. Staff in the home are supported by 2 General Practitioners and a consultant psychiatrist in meeting the medical need of clients. As clients are being supported in withdrawal from addictive substances, they do not administer their own medication, however they are expected to attend the nursing office at the set times to receive their medication. During the inspection the inspector observed clients arriving at the nursing office for their medication, one was turned away because it was not yet time for their administration and instructed to return in half an hour - the inspector observed that an hour and a half later the client had not returned and the nursing staff had not searched them out to remind them to attend the office to receive the prescribed therapeutic medication. Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 13 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): 23 There are policies about protection but not all staff were aware of them this could adversely affect the safety of clients. EVIDENCE: Broadreach has a clear complaints procedure, which was displayed in the home; this inspection took place in response to a complaint made directly to the commission. Most aspects of the complaint had also been communicated in writing to the management team and the inspector was shown documentation which provided evidence that the issues were being taken seriously are being investigated and was informed that an action plan would be devised and reviewed based on the findings. There was evidence found in the personnel file seen during the inspection that it is mandatory for staff to receive training in the protection of vulnerable adults. A record seen in the personnel file had been signed by the staff member to say that they had been made aware of the grievance discipline and whistle blowing policy and staff harassment and victimisation policy however 3 members of staff spoken to at the time of the inspection said they were unaware of the homes whistle blowing policy. The inspector was provided with a copy of the latest grievance, discipline and whistle blowing policy issued April 2005 due review April 2006 this was included in the procedural manual which she was told is kept in the front administration office. Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 14 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): 0 None of these standards were assessed on this occasion. EVIDENCE: Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 15 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): 31,32,33,34,35,36 A full multi disciplinary team of staff are employed to support clients needs. Staff teams do not work cohesively, some staff are not supported adequately or lack development plans this impacts on their ability to meet the needs of clients. Staffing levels are sometimes inadequate. The home does not consistently use effective employment systems this has the potential to place clients at risk. EVIDENCE: A range of registered nursing, care and counselling staff are employed at Broadreach as well as administrative, financial, training and ancillary staff. Discussions with 3 nursing staff showed that they do not feel they have been supported in extending and developing their skills in light of the fact that they were newly employed and said Broadreach is a very different environment to those that they had experience of. These staff also intimated that more experienced staff had said to them that the needs of the clients were changing and becoming more challenging to manage and support. One nursing staff member said that they had identified training needs with their line manager (3 months earlier) at the time of a formal appraisal but had yet to be given access to the identified training on Control and restraint and first aid. Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 16 Four nursing staff spoken to said that at times they felt staffing levels were inadequate particularly at weekends and some evenings, when on occasions there is only one nurse and one counsellor on duty, these staff communicated a fear that this low level of staff may impact on their safety and that of the clients. Three incidents had been recorded relating to staffing levels since November 2005. Staff rotas showed that in the nursing department there is usually 2 on duty in the morning and 6-8 councillors on duty during weekdays, at weekends and evenings this is decreased to one nurse and one councillor with counsellors and a manager on call, staff confirmed that if requested they do attend. Nursing Staff told the inspector that they did not always feel well supported, they and care staff do not receive supervision in accordance with the standards. The inspector advised that small group supervision and supervised practise might be a way of progressing this area. The inspector looked at one Personnel file, documentation within this file showed that references had been requested after the individuals’ employment commenced and there was also no copies of photographic evidence of identity or qualifications. There was no documentary record of the interview process so the inspector is unable to comment on its effectiveness or equality and fairness. The file did contain an orientation and induction checklist but recently employed staff who were spoken to did not feel that these written processes had been particularly useful in practise. Records of training provided evidence that mandatory training includes protection of vulnerable adults, diversity and health and safety. Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 17 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): 38,40,42 There has been a breakdown in management systems and processes this has resulted in some staff feeling undervalued and deskilled which may impact on the overall care provided to clients. EVIDENCE: This inspection took place in response to a complaint. The complainant alleged that staff are put under pressure by management to work excessive hours to maintain required staffing levels and are given the impression that disciplinary action would be taken if they refuse to work. The inspector found that a number of staff in the home are afraid that the number of staff on duty could impact on their safety and that of clients. Experienced staff said that in their experience of this challenging and risk associated environment that this had actually rarely been the case. A Number of staff spoken to during the inspection felt that management did not listen to their concerns either about staffing levels or security systems. There was documentary evidence seen that one staff member who had followed the grievance procedure by putting their concerns in writing to the management team had indeed instigated an internal investigation which the Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 18 inspector was shown evidence of and was informed would result in an action plan and review of processes and procedures. A recent critical incident analysis had resulted in a finding that there had been a fundamental breakdown of systems and processes and there was a lack of clear protocols. The findings of this analysis had been discussed with all staff at meetings in November and included systems for preventing admissions after 5.00pm and ensuring doors are locked after dark and spot checks are performed at regular intervals. There was evidence of a lack of regular departmental meetings for some departments particularly with the nursing department not having had a meeting since July 2005. Formal communication systems about the needs of clients were found to be in place with twice daily meetings between the nursing and counselling departments and between shifts at staff handovers. Health and safety meetings are held regularly with representation from all departments, one attendee told the inspector that they had not felt listened to at the latest meeting and it had felt like they were banging there head against a brick wall. Where health and safety issues had been identified in the past there was evidence that action had been taken to address or minimise risks for example Walkey Talkeys had been supplied for use by staff when only 2 members on duty to ensure they could communicate wherever they were situated in the building. Staff told the inspector these were no longer used because they were not reliable but this had not been communicated to management in a formal manner staff spoken to said there was a feeling of ‘them and us’ between different departments and management. The inspector was shown the latest monthly management report about occupancy and budgets, which provided evidence that the management team do communicate with each other in varied formal ways. The inspector found that the most recent Policy and procedural manuals are kept in the front admin office and out dated policies were found in the nursing department. The Health and Safety policy found in the nursing department was dated 1995. Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 19 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 Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X 3 Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 2 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 2 2 2 1 2 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Broadreach Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X 2 X 2 X 2 X DS0000003576.V262080.R02.S.doc Version 5.0 Page 20 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 23 Regulation 13(6) Requirement Timescale for action 01/03/06 2 33 18(1)(a) 3 36 18(2) All staff must be aware of the procedures for responding to abuse or neglect (including Whistle blowing) The ratios of care staff to clients 01/04/06 must be determined according to the assessed needs of residents and a system operated for calculating staff numbers required. All staff must have regular, 01/03/06 recorded supervision meetings at least six times/year with their senior manager in addition to regular contact on day to day practise in accordance with standard 36.4 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 Refer to Standard 14 Good Practice Recommendations A review on social activities available at weekends should DS0000003576.V262080.R02.S.doc Version 5.0 Page 21 Broadreach 2 3 20 31 4 32 5 35 6 7 8 38 40 42 be performed and plans put in place to meet any identified shortfall in provision. Therapeutic Care pathways that include the regular administration of medication should be adhered to in line with best practise recommendations. All staff should know and support the main aims and values of the home and understand and implement the homes policies and procedures, and know how their work, and that of other staff, promotes the main aims of the home. Systems should be put in place that ensure all Staff should respect clients and have attitudes and characteristics that are important to them including being accessible and approachable by and comfortable with clients, good listeners and communicators, reliable and honest and interested, motivated and committed All staff should receive structured induction training, which includes training in the principles of care, safe working practises, the organisation and worker role, the experiences and particular needs of the client group and the influences and particular requirements of the service setting. More robust strategies for enabling staff to voice concerns and to affect the way in which the service is delivered should be considered. All staff should have access to up to date copies of and understand and apply all policies, procedures and codes of practise. The registered manager should ensure that risk assessments include consideration of security matters and that any significant risks are recorded and action taken to minimise that risk e.g. through staff training. Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Broadreach DS0000003576.V262080.R02.S.doc Version 5.0 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!