Inspection on 18/06/07 for 124 Brook Drive

This inspection was carried out on 18th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

124 Brook Drive 26/08/09

124 Brook Drive 29/12/05

124 Brook Drive 24/08/05

124 Brook Drive 10/06/04

124 Brook Drive 11/03/04

Similar services:

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Herbert Street

Haven (The)

Charis

Hartley House

Rugby House Project

City Roads Crisis Intervention

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

CARE HOME ADULTS 18-65 Equinox, 124 Brook Drive Kennington London SE11 4TQ Lead Inspector Ms Rehema Russell Unannounced Inspection 18th June 2007 09:00 Equinox, 124 Brook Drive DS0000007019.V341662.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 Equinox, 124 Brook Drive DS0000007019.V341662.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. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Equinox, 124 Brook Drive Address Kennington London SE11 4TQ 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) 020 7820 9924 020 7735 9511 brian@brookdrive.equinox.org.uk Equinox vacant post Care Home 14 Category(ies) of Past or present alcohol dependence (0), Past or registration, with number present drug dependence (0) of places Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 14 patients Persons aged 18 years and above, undergoing detoxification from substance misuse Day care facilities for up to 4 persons, aged 18 years and above, to receive medication only, for detoxification from substance misuse 29th December 2005 Date of last inspection Brief Description of the Service: Equinox Brook Drive is situated in a residential street, a short walking distance from a shopping centre which has transport and recreational facilities. The building has three floors plus a basement and the detoxification unit occupies the majority of the ground floor. The basement floor has offices; the ground floor has the detoxification unit for 14 persons (bedrooms, bathrooms, toilet, medication room, lounge, dining room), reception/staff room, and a separate area of interview rooms; the first floor has the main kitchen, large dining room, communal lounge, women-only lounge, quiet room, toilets and offices; and the top floor has the hostel bedrooms. The detoxification unit provides a minimum 10-day detoxification programme for both drugs and/or alcohol detoxification in regimes that are adjusted to meet individual needs, offering a full nursing assessment and also a general practitioner who is on the premises for five mornings per week. The unit provides high quality accommodation and food, a non-judgemental ethos, group work, access to complimentary and other therapies and an experienced and multidisciplinary staff team. Once the programme is completed, residents have the opportunity to access the 21-day assessment programme in the hostel upstairs. New service users are given the Statement of Purpose and Welcome Pack (containing the service users guide). A copy of the latest inspection report is available in the office, or via referral to the CSCI website, and fees range from £165 - £200 per day. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 18th June 2007. The inspector spoke in depth with the registered manager, the assistant manager for care, three service users (2 male, 1 female), two substance misuse workers, one of whom has been at the home for 8 years and one of whom is the newest recruit and has been at the home for 6 months. The inspector also spoke briefly with the assistant manager for nursing, toured the premises and looked at documentation and records. The inspector was told that the Registered Provider is considering expanding the home adding a first floor above the current detoxification unit wing that will increase detoxification bedrooms from 14 to 18 (including converting the current 2 double bedrooms to singles) and will be fully wheelchair accessible. It is also considering converting the programme to 21 days. What the service does well: What has improved since the last inspection? Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 6 The two requirements arising from the previous inspection of 29th December 2005 had been implemented: staff’s CRB reference numbers are kept at the home, as are copies of the monthly Registered Provider reports. What they could do better: 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. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 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 Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective service users are given clear written and verbal information on which to make an informed choice and they have their needs and aspirations fully assessed. Each service user has an individual support agreement and licence agreement, which state the terms and conditions within the home. The nature of the service precludes trial visits. EVIDENCE: All service users are given a brochure, welcome pack, licence agreement and support agreement. These have all of the information required by regulation and also outline service users’ rights and responsibilities, key worker functions, the House Rules, and information in regard to pets, visitors and other restrictions. These documents are clear and easy to read, and the licence and rights and responsibilities documents clearly state that breaches of equal opportunities principles will not be tolerated. The programme, rules and restrictions of the home are also explained verbally on admission and again two days after admission when the service user is less frail/intoxicated. This information is also explained at regular Monday information group sessions, which service users said were useful. Admission procedures were seen on files and were detailed and thorough. There is a six page pre-assessment referral form for those referring service Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 9 users to the home fill in and then the home’s own admission form. This includes a nursing assessment, covering drugs use, physical and psychological needs and consent for General Practitioner information, and a risk assessment. These documents were seen on files and were all signed by the service user. Staff ensure that any dietary, cultural or spiritual needs of service users are assessed and provided for and have at various times provided interpreters, local ministers, Alcoholics Anonymous sponsors etc. to act as advocates. The home ensures that its’ programme follows current good practice and relevant specialist and clinical guidelines by having developed good links to various specialist services, including having a GP service on the premises for five mornings each week. Due to the nature of the service provided (first stage detoxification), prospective service user visits are inappropriate. Signed and dated licence agreements were seen on individual files. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users’ assessed and changing needs are reflected in their individual plans. Service users are supported and encouraged to make decisions about their future lives after detoxification and are regularly consulted on all aspects of life in the home. Service users are supported to take risks within the parameters of the detoxification programme. EVIDENCE: Care plans were seen for two of the three service users spoken with. They were clearly laid out and thorough, with all of the relevant information required including a signed and dated care/support plan and planned review dates. Care plans demonstrated follow up of the issues raised on pre-admission and admission assessments and the contact sheets showed that each service user is spoken with by staff at least twice per day, sometimes up to three or four times. Service user said that “staff always have time for you” and “pick up when you are down and speak with you”. Daily notes were full and detailed so that it was easy to track the progress or otherwise that service users were Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 11 making. A detailed Client Profile is filled in on the fourth day after admission, giving the full substance history, past treatment and physical health of the service user, signed by them and the substance misuse nurse. There are various limitations to service users’ rights due to the nature of the programme at the home e.g. restrictions on going out of the home without an escort, no visitors are allowed apart from professionals and supervised children visits, no mobile phones are allowed. These, and the reason for them, are clearly explained to service users before admission and during their stay. Apart from these restrictions and the House Rules, service users make all major decisions about their future lives, for example whether they go on to further rehabilitation and where, and all service users manage their own finances. Service users give informal feedback to staff on a daily basis but there are also four formal ways in which service users are consulted on and encouraged to participate in aspects of life at the home. These are weekly information groups, fortnightly service users groups, the complaints system and client satisfaction surveys. Service users groups are attended by management and information is exchanged on policies, housekeeping, requests for new equipment etc. In response to service users’ concerns about safety, and on their suggestion in the service users group, management recently changed the time for service users’ to report back to the home in the evening from 10 p.m. to 9 p.m. Similarly, from service user group suggestions, management have made more activities available in the home and in the future will be providing additional activities at the weekend. Service users said they felt listened to. A risk assessment for every service user is completed on admission, covering areas such as suicide, mental health, violence, arson, sexual behaviour, physical health and housing. If any risk is identified on admission, a full assessment is undertaken on how the risk is to be managed. Each detailed risk assessment then forms part of the service user’s care plan and is regularly reviewed. Service users are given information on how to manage risks and recognise triggers during group work sessions and the twice daily individual sessions with their key worker or other substance misuse worker. In regard to missing persons procedures, the risk of absconsion forms part of the initial assessment and the choice of whom to inform is discussed with the service user, as is appropriate to the aims and objectives of the home’s programme. It is explained to service users that they are not permitted to leave the home for more than 4 hours without permission, and that if they do this and return they will be discharged. In these cases, or if a service user does not return to the home within 24 hours, the referral agency is informed. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have full opportunities for personal development. Service users are able to take part in activities and the local community within the restrictions of the home’s programme. Personal and family relationships are restricted in keeping with the home’s aims and objectives. Service users’ rights and responsibilities are respected and supported. Service users are offered a healthy diet and enjoy their meals. EVIDENCE: The programme at the home is aimed towards giving service users the opportunity to learn coping mechanisms and about relapse management and life skills i.e. how to maintain and develop social, emotional, communication and independent living skills without dependence on addictive substances. Service users are expected to attend two group sessions each day, which cover topics such as coping with anxiety, high-risk situation management, assertion, Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 13 coping with stress and self-awareness. Practical daily living skills can also be practised during their stay at the home via housekeeping chores such as using the microwave and being responsible for keeping their rooms reasonably tidy. Group work is a source of assertion and confidence training for service users, who are also encouraged to attend Alcoholics Anonymous & Narcotics Anonymous meetings in the evenings. Service users are free to arrange fulfilment of their spiritual needs themselves and staff facilitate exceptions to the first 96 hours restrictions if this is for the observance of faith. As this is a 14 day detoxification programme, it is too early in service users’ recovery to take part in employment, education or training activities. However they are able to start planning for these activities, and to take part in cookery sessions and other domestic chores, if they progress to the second stage of the programme (which is not a registerable service). Due to the short time period and the necessary restrictions of the detoxification programme, service users do not fully integrate into the local community. They do however access the shops, banks, health and sports facilities and transport, initially whilst being escorted and then on their own. The home provides an extensive library, board games, television, DVD facilities, radios in each bedroom and there is a baseball hoop and snooker table upstairs. There is also a quiet lounge for women only, located on the first floor. Several service users mentioned that they find weekends boring and so the home is going to provide more activities at the weekend, such as an art group. However, service users said that they really enjoyed and appreciated the trips out accompanied by staff during the week, such as for coffee, for a walk, to bowling, the hard rock café and the London Eye. No visitors, other than professionals, are allowed during the detoxification programme. However, supervised visits by children under 16 can be arranged by key workers and take place in either of the two offices that are situated on the ground floor behind a key padded door. Service users do not have access to this area of the home unless accompanied by staff. A pay phone is provided in the communal area so that service users can contact their families during detoxification, and all service users are accompanied by escorts if they travel outside the home. Service users are not permitted to have exclusive relationships with other service users whilst at the home. This is explained and made clear in the Welcome pack information given to all service users and codependency issues are discussed in group sessions. In regard to service users’ rights and responsibilities it was found that these are respected and supported, within the parameters of the detoxification programme. Service users are able to get up when they please in the morning, limited only if they need to take medication at prescribed times and by the expectation to attend 11.30 a.m. group sessions. Breakfast can be taken at any time. Lunch and dinner are served at set times but there is a microwave Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 14 facility so that service users can choose to consume their meals at other times. The only restrictions to service users’ rights and responsibilities are those dictated by the detoxification programme and explained on admission. For example, service users must adhere to the medication times in order to establish a routine as opposed to the chaos of using, and post is opened in the presence of staff to prevent the possibility of substances being obtained/sent. Service users are also encouraged and supported to develop skills and responsibilities via allocated household tasks, such as loading the dishwasher or helping with cooking. The home provides healthy, nutritious and varied meals. A cooked meal is provided twice a day and service users prepare their own breakfasts. The chef prepares and serves both midday and evening meals and prepares the main weekend dishes in advance, with very clear and detailed instructions for service users. All of the dishes and any sauces used are hand-made; ethnic meals and any specialist medical/other dietary needs are provided for and there is always an alternative choice available. Fresh fruit and snacks are available daily and there is a microwave provided for service users to reheat food if appropriate. The home has water dispensers in all communal areas so that service users can readily and easily access water, which is good practice for a detoxification unit. Service users spoken with praised the quality and quantity of food provided. Comments included “the food is good and there is lots of it”, “the food is great, there is always enough”, “there’s always food, you can get something to eat or drink 24 hours a day” and “there’s always biscuits, cheese, ham, salad, yoghurt”. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Sensitive personal support is given in a manner that promotes the dignity and independence of service users, and service users’ physical and emotional health needs are met. Service users are protected by the home’s policies and procedures for the storage, administration and recording of medication EVIDENCE: Service users do not require personal physical support but some service users may need verbal prompting in regard to physical hygiene and physical hygiene management. Service users confirmed that any such prompting is given in a manner that safeguards their independence and dignity, and handled sensitively if it is discussed in communal meetings. One service user said “staff are attentive to everybody’s needs” and “they are very conscious of dignity and respect”, another said “staff are sincerely caring, not just doing a job”. If service users require or would benefit from physiotherapy, speech therapists, osteopathy etc., these are arranged by the key worker via the GP, and appointments are facilitated by the home. Service users retain the same key worker for the whole month of the detoxification programme and every third day the daily sessions are conducted by the service user’s key worker. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 16 The key worker can therefore co-ordinate the daily information gathered and the care plan and arrange for appointments and follow-up on personal support requests. The service has a General Practitioner from the local surgery on site every weekday morning, which far exceeds minimum standards and provides service that is not found at other detoxification centres. It ensures that all service users are medically assessed on admission and at other times, and that the detoxification process is closely monitored. The GP sees all new service users, checking their substance misuse history and picking up any new issues arising. The GP can also refer service users directly to a specialist/department at a hospital if appropriate. The issuing and changing of prescriptions is also greatly aided by having a GP on site. Any other healthcare facilities needed e.g. dentist, chiropodist, optician, are arranged by the staff or by the service users themselves. Complimentary therapies are also provided by the home on site. One service user said that he had attended shiatsu and reflexology for the first time and had been very surprised at the effects of the reflexology, at how deeply relaxed he had become and how very good he had found it. Due to the nature of the programme, service users do not administer their own medication. Medication is stored in a large locked cabinet in a room used only for medication administration and medical procedures. The main medication cabinet and the controlled drugs cupboard meet the required standards. Storage, administration and recording of medication were checked, including controlled drugs, and no problems were found. Regular checks of all medication stock is undertaken by the nurse manager, which is good practice. There are clear and detailed protocols for the administration of methadone and its use as a reducing programme and a double entry system is used for recording. The home now offers an alternative to methadone for opiate detoxes, which is also good practice. As service users remain at the home for a period of one month only, Standard 21 regarding the ageing, illness and death of service users is not applicable. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 17 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, 23 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users’ views are listened to and acted upon. Service users are protected from abuse, neglect and self-harm. EVIDENCE: There have been 23 formal complaints made at the home during the past 12 months, but the vast majority of the complaints were from service users about each other. Every one of these complainants had been seen by management within one working day and resolved, the complainant being informed of the outcome either verbally or by letter. The one working day response to complaints far exceeds minimum standards. Four of the 23 complaints were upheld, with appropriate action taken. The complaints file was seen, each complaint having a number, date, name, whether complaint substantiated or not, and date completed. It was noted that when complaints had been made about service users breaching equal opportunities, for example by using offensive language in group sessions, the home had already dealt with the issue by asking the service user to leave the home, as outlined in service users’ licences and rights and responsibilities documents. Service users spoken with were aware of the complaints procedure at the home and how to make a formal complaint, although they said that if anything was wrong they could easily speak to any member of staff, that “staff always get back to you” and that “everything is confidential”. Staff spoken with were fully aware of the home’s abuse policy and procedures and the various types of abuse that may occur. Complaints and whistleEquinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 18 blowing procedures are read and signed for during staff induction, adult protection issues are fully explained during NVQ Level 3 training and form part of induction training for new employees, and any updates to the policies or procedures are discussed at team meetings. In addition, substance misuse nurses are bound by National Medical Council protocols and substance misuse workers are given the GSCC codes of professional conduct. Service users’ mood swings and behaviours are discussed and noted daily at handovers and staff spoken with were trained in how to manage verbal or physical aggression. All service users access their money on a daily basis and staff do not withdraw money on behalf of service users. There has been one allegation of abuse at the home since the previous inspection of 29th December 2005. This is currently under investigation. All of the proper procedures had been followed, all of the relevant authorities informed and the manager has followed the adult protection protocols of the local authority in which the home is located. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 19 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, 25, 26, 27, 28, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users live in a homely, comfortable and safe environment. Bedrooms meet individual needs and toilets and bathrooms provide sufficient privacy. There is suitable and sufficient shared space and the home is clean and hygienic throughout. Aids and adaptations are provided to maximise service users’ independence as required. EVIDENCE: The home’s premises are accessible, safe and well maintained. It has its own private entrance off the street and a ramp and stairs to the front door. CCTV cameras are used to ensure security, but only at the entrance and outside areas of the home so that they do not intrude on the privacy of service users. There is an open window/hatch at the reception office by which anyone wishing to enter the home can be vetted before being allowed in. There is no garden by area of the car park has been paved over, making a pleasant seating area with pergola, where service users can relax in the sun and where barbecues are held. Service users said it was “nice to sit outside on sunny days”. Full Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 20 transport facilities are available within a few minutes walk of the home and the home has its own vehicle which has been adapted for wheelchair use. This transport is used for service users’ appointments and evening meetings and also for day trips and outings. There are 10 single bedrooms and two doubles, all being above minimum size standards. The windows have suitable locks and although service users are not given keys to their bedrooms due to the nature of the programme, they all have snib locks so that they can lock their rooms from the inside. Bedrooms do not have television points, to encourage service users to benefit from company in the communal areas and discourage tem from isolating themselves. However the home has recently supplied radios for each service user. Three service users’ bedrooms were seen. They were simply but well furnished, with good quality furniture, fittings, bed linens and curtains. Service users said their rooms were “good, comfortable”, “nice and always clean”. There are two shared bedrooms, both separated internally by full length curtain partitions. If only a double bedroom is available, service users are offered the choice of accepting admission to a shared room or waiting until a single room becomes available. If service users choose to accept the shared room then staff make all efforts to ensure that service users are matched by gender or any other relevant need. The home has sufficient bathrooms and toilets, suitably equipped for the needs of the service users group and with suitable locks. One of the ground/detoxification floor shower rooms is kept for the use of women only, which is good practice. All communal areas are bright, attractive and comfortable with high quality décor, furniture and fittings. There are framed pictures and ornamentation throughout the home, including positive images of other cultures. The home has sufficient and suitable shared space. There are two communal rooms in the detoxification unit – one is the dining room, which is also used for group work, and the other is the lounge, which has sofas, chairs and television & video. All furniture gets very hard wear and tear, due to the short length of stay at the home and therefore the high turnover of service users. At the previous inspection of 29th December 2005 service users had said that the ground floor lounge sofas were uncomfortable and required more cushions. At this inspection the two sofas in the ground floor lounge were found to be uncomfortable to sit on and the sofa in the first floor women-only lounge was torn and shabby. It is therefore recommended that all three sofas are replaced. See Recommendation 1. There is a ramp to the entrance of the home, and as the outside seating and pergola area is on ground level it is also mobility accessible. The home provides one bedroom on the ground floor which is fully adapted for disability and there are suitable aids and adaptations in bathrooms and toilets to Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 21 facilitate disability access. A service user with mobility restrictions would therefore have access to all of the facilities in the detoxification unit. The main kitchen is on the first floor but there is a dumbwaiter to the ground floor dining room and the day’s menu is displayed on a board in both areas. The dining area also has facilities for hot and cold drinks, which service users can access as they wish. The laundry, which is located on the first floor, has washing machines and tumble-driers and some storage space. The home is kept to a very high standard of hygiene and cleanliness, which service users commented positively on and which is a major achievement given the nature of the programme at the home and the constant turnover of service users. The home employs a fulltime housekeeper and two fulltime cleaners/handypersons, who are commended for the cleanliness standards at the home. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are clear about their roles and responsibilities and service users are supported by qualified, appropriately trained staff and an effective staff team. Staff confirmed that the home conducts a thorough recruitment procedure as well as regular supervision and appraisal. EVIDENCE: There are both substance misuse workers and substance misuse nurses at the home, the latter all being qualified nurses. Only substance misuse workers administer medication, take medical observations and dress wounds and injuries if they arise. In all other ways, the roles are the same. Staff get to know and develop relationships with all service users via assessments, daily interviews, key work sessions, information exchanged at daily handover and normal day-to-day contact. Observation and verbal feedback from service users indicated that staff develop open, friendly and supportive relationships with service users. Service users said that staff were “nice, attentive to everybody’s needs”, “very conscious of dignity and respect”, “friendly, attentive, always willing to give information”, “are very good facilitators”, Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 23 “make it very comfortable”, “don’t let you suffer in pain” and “are sincerely caring and listen”. Staff at the home are suitably trained and qualified for their roles. Applications are not considered unless the candidate had previous experience in the substance misuse field. The substance misuses nurses all are either RMN or RGN qualified. Three substance misuse workers have completed NVQ Level 3 and three are in the process of obtaining it. Both night workers have attained NVQ Level 2. The home has therefore exceeded the recommended 2005 NVQ Level 2 target. The Registered Provider has an annual corporate training plan which includes a 5-day induction and a yearly training programme that is led by appraisal. Basic internal training on substance misuse is provided and staff are supported and encouraged to access the range of PCT and NTA training that is available. Examples of courses attended by staff recently include equality & diversity, fire safety, alcohol & the elderly and crack cocaine awareness. The Registered Provider has a Equality Service Plan, which is good practice, and under this has ensured that all staff have undertaken Equality & Diversity training provided by an external trainer. The home has an effective staff team, which is diverse in gender, ethnicity and culture, and hence suitable to the service user group. Specialist services are sought and/or service users supported to contact them as appropriate. There is always a level 1 nurse on duty during the day, along with a member of the management team, substance misuse workers and group workers. At night there are two waking staff, one of whom is a nurse. There are never less than two members of staff on duty at the home at all times and the home has low levels of sickness and agency staff use. The inspector interviewed a new member of staff, a substance misuse worker who had joined the home in January 2007. She described the recruitment process that she had undergone, which demonstrated that the Registered Provider has a robust recruitment procedure that meets all of the requirements of legislation and safeguards service users. The previous two reports of 24th August 2005 and 29th December 2005 required the Registered Provider to ensure that a list of relevant CRB information for all staff employed at the home is kept there permanently, and at this inspection the registered manager said that this was being done. The Registered Provider has adopted the policy of checking on all staff’s CRBs every three years, which is good practice. Staff confirmed that monthly supervision and annual appraisals take place. They also confirmed that staff meetings are held monthly, with staff approving draft minutes before they are finalised, and staff able to access the minutes at all times from the duty office. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 24 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, 38, 39, 42 Quality in this outcome area is (excellent, good, adequate or poor)This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home and from the positive leadership and management approach of the home. Service users views are regularly sought and acted upon. The health, safety and welfare of service users are promoted and protected. EVIDENCE: The Registered Manager is suitably qualified and experienced to run the home and has obtained NVQ Level 4 in care and management. The assistant manager for care has many years of experience at the home and NVQ Level 4 in care, and the assistant manager for nursing is a qualified RMN. The management team at the home communicates a clear sense of direction and leadership and observation indicated that their management style is open, Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 25 friendly and inclusive. Staff said that managers were “very open and approachable”, that “the door is always open” and that “we can contribute, and feel part of a team” and that the “whole team is supportive”. The registered manager has a pro-active and inclusive approach to any issues that may affect service users or staff. For example, the manager has prepared service users and the home for the new smoking legislation on July 1st 2005 well in advance of its implication. The service user group was increased from fortnightly to weekly so that service users could become familiar with the impact of the changes the legislation will bring, for example that as inside they will no longer be able to smoke in the lounge they will have to smoke in their bedrooms and this will prevent companionship and support from each other. As this peer support is an important element of the programme and experience at the home, ways of lessening the impact of the legislation are discussed. Service users will be able to smoke outside but have themselves said that they would caution against indoor smoking rooms as these have been experienced negatively in hospitals/other placements. Further preparations are that the new smoking regulations will be introduced two weeks prior to July 1st in order to help service users get used to them, and the home will provide professional smoking cessation remedies, for example via GP prescription. There are several ways in which service users’ views are sought and acted upon by the home. Service users groups are held bi-weekly, chaired by the Registered Manager, at which service users views on any aspect of life at the home are sought, suggestions and complaints acted upon, minutes kept and follow-up action fed back at the next meeting. There is a suggestion box just outside the duty office, where it is accessible to all service users. Two group work sessions are held each day at which issues can be raised, and client satisfaction surveys are carried out at the end of the programme. The latter asks service users their views on several areas including admission, orientation, medication, food, groups, keyworkers, complimentary therapies, goals, complaints and suggestions. A summary of service users’ views was published in the form of pie charts in 2005 and it is recommended that the results of these surveys are printed up annually to fulfil the recommendation of Standard 39.4. See Recommendation 2. In addition to seeking service users’ views, the home obtains feedback on its programme through the GP’s occasional attendance at the weekly management meeting and by staff attending the quarterly monitoring meetings held by the three main Commissioners of Lambeth, Southwark and Lewisham. Monthly Regulation 26 visits are carried out by the Registered Provider and copies are kept at the home and were seen. The manager confirmed verbally and in writing that all of the health and safety checks required to be regularly carried out and/or certificated by regulation had been carried out and were up to date. The inspector was shown the Fire Risk Assessment written by the manager, and this was found to be very detailed and of high standard. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 26 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 4 2 4 3 3 4 N/A 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 3 27 4 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 4 3 X LIFESTYLES Standard No Score 11 3 12 N/A 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 N/A 3 4 3 X X 3 X Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 27 No 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. Standard Regulation Requirement Timescale for action 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 YA28 YA39 Good Practice Recommendations The two sofas in the ground floor lounge and the sofa in the women-only lounge should be replaced. An annual summary of service users views should be printed up and made available to potential service users and interested parties. Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH 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 Equinox, 124 Brook Drive DS0000007019.V341662.R01.S.doc Version 5.2 Page 29 - 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. 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