Inspection on 26/07/06 for Chandos House

This inspection was carried out on 26th July 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chandos House 03/07/07

Chandos House 25/01/06

Chandos House 20/09/05

Chandos House 21/03/05

Chandos House 21/01/05

Chandos House 03/03/04

Similar services:

Clouds House

Closereach

Westcliffe House

Hilldales

Longreach

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 Chandos House 36 Chandos Road Redland Bristol BS6 6PF Lead Inspector Sandra Gibson Key Unannounced Inspection 26th July 2006 10:00 Chandos House DS0000026580.V296654.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 Chandos House DS0000026580.V296654.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. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chandos House Address 36 Chandos Road Redland Bristol BS6 6PF 0117 9243071 0117 9243071 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) Ms Joyce M Dickinson Mr James Dickinson Care Home 10 Category(ies) of Past or present alcohol dependence (10), Past or registration, with number present drug dependence (10) of places Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th January 2006 Brief Description of the Service: Chandos House is operated by Mrs J Dickinson and is registered by the Commission for Social Care Inspection to provide secondary care residential treatment for up to ten males, aged 18 - 65 years who are recovering from drug and alcohol dependency. The management team are committed to the twelve-step programme and aim to provide a holistic environment, which combines the use of counselling with alternative therapies. Residents are expected to participate in an activities programme that includes group and individual therapy sessions, as well as focusing on life skills. Chandos House is not intended to be a home for life and an average stay lasts no longer than six months. The service is not staffed during the evening or at the weekends. Arrangements for support in an emergency are in place. The home is accommodated in a large Victorian house, which is situated over four floors. There is no lift facility and the accommodation would not be suitable for wheelchair users. It is situated in a residential area, close to local amenities and major transport routes. Fees are currently in the range of £510£550/week. This information is provided verbally to prospective service users prior to admission. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was unannounced key inspection conducted midweek between the hours of 10:00am and 5:15pm. Evidence was gathered from: Examining previous correspondence with the home, inspection reports, information from pre-inspection questionnaire, residents surveys (6) GP comment cards (1), Health and Social Care Professionals survey (4) talking to/observing residents, talking to owner/ registered responsible individual, talking to the registered manager treatment coordinator /talking to the Business development manager/ talking to staff/ volunteer, talking to and case tracking three residents, talking to one relative examining records, policies and procedures. What the service does well: The care planning system in place is good. The system in place ensures that residents changing needs continue to be fully identified. Staff have a good awareness of individuals needs and rights and treat the residents in a warm and respectful manner, which means that residents can expect to receive care and support in a secure setting Residents are supported to take risks as part of an independent lifestyle within Chandos House and out in the community. Chandos House provides residents with the opportunity to engage in a rehabilitation programme, which helps them, prepare for a lifestyle that is free from drug and alcohol dependency. Meals are well managed and provide daily variation, good nutrition, life skills and social contact for residents. Residents’ physical care and emotional health needs are fully met and support and counselling is delivered in a way that meets the individuals’ assessed needs. Chandos House continues to provide a clean, comfortable, safe home. The complaints procedure in place is satisfactory with the result that residents have the detailed information they need to make a complaint. Chandos House is kept under constant review and development by the experienced management team, which ensures that the residents benefit from a well run home. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Chandos House DS0000026580.V296654.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 Chandos House DS0000026580.V296654.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Information about the Chandos House Treatment Centre provided to prospective residents and their representatives is of an adequate standard and has been developed further since the last inspection. However, further attention is required to ensure that all prospective residents have clear detailed information so that they are able to make an informed decision about whether the treatment centre can meet their individual care needs. The admission procedure has improved since the last inspection . Arrangements in place now ensure that a person’s needs have been fully assessed prior to moving into the treatment centre so that the staff know that an individual’s needs can be met at Chandos House. EVIDENCE: There is a detailed statement of purpose in place in this home and a service users guide has recently been developed to a potentially good standard with the use of photographs and comments from previous service users. The new service user guide was examined and although the majority of the contents were good a number of gaps in information were also found. Gaps in the information required included: details of the experience and qualifications Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 9 of the registered manager and responsible individual and other staff working in the home, age range of residents, details of the fees etc. The information leaflet developed a number of years ago is currently given to prospective service users before they visit the treatment centre. The Business development manager explained that as soon as the service user guide is completed then this would be provided to all prospective residents. Residents spoken to during the inspection said that they had heard about Chandos House through “word of mouth” and by a representative from their funding a their fund looking at the Commission for Social Care Inspection website. Resident’s surveys confirmed that they had received enough information about the home before they made their decision that it was the right place for them. A sample of records was inspected and it was noted that all of the individual records included a detailed and comprehensive pre-admission assessment conducted by staff from Chandos House. There was also evidence of needs assessments in place conducted by the care managers from the funding authorities. Residents admitted to Chandos House come from a number of different local authorities. The Business development manager said that some local authorities still failed to provide this information without written prompting from him. He confirmed his understanding of the importance of coordinating this information prior to a new service user being admitted to Chandos House and indicated that he would continue to pursue the funding authorities for needs assessments as required. Potential residents complete an application form for admission to the home and are usually offered the opportunity to spend a day and overnight stay where practicable. This gives them the opportunity to meet the existing group of residents, have discussions with the staff and get a fuller understanding of the ethos of the home. One resident said that “ After considering other secondary residential rehabs and completing all the assessments. I made a decision to move into Chandos. This decision has been based on the quality they have to offer. This includes the accommodation, the programme, the staff and most importantly the overall support I get here”. Other residents said, “I was given a choice of Rehab from my funder and I chose Chandos House because of people, environment and attitude” and “the reputation proceeds it”. A sample of records inspected confirmed that residents are provided with a written contract/statement of terms and conditions, which they are required to sign on admission. It was noted that this information contains house rules, their rights and obligations. Chandos House DS0000026580.V296654.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The care planning system in place is good. The system in place ensures that residents changing needs continue to be fully identified. Staff have a good awareness of individuals needs and rights and treat the residents in a warm and respectful manner, which means that residents can expect to receive care and support in a secure setting Residents are supported to take risks as part of an independent lifestyle within Chandos House and out in the community. EVIDENCE: A sample of residents care plans examined confirmed that these were compiled from person centred assessments, which means that staff put the views, wishes, likes and dislikes of each resident at the centre of all care provided. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 11 The information for each resident was very informative and useful enabling staff members to instantly provide the appropriate care to support their health emotional / mental health needs and social and educational needs. From the assessments staff had identified needs enabling them to form written care plans. These were written clearly and concisely and in a sense that the residents had contributed to the implementation of each plan. Hospital appointments, visits to the General Practitioner and any other professionals are recorded to provide a history and quick reference guide. The care plans examined demonstrated that staff were ensuring that residents were safe within their home and out in the community. Residents continue to be supported to take risks as part of living an independent lifestyle. This was evidenced by conversations with residents about different activities and outings they had participated in the community. This information was confirmed in resident’s surveys. One resident said, “ Chandos is a well structured House and we are given boundaries to comply with in the evening s and weekends. We are given trust on what to do and where to go, decisions are usually made in a group meeting”. Another resident said “I can arrange my daily timetable in accordance to my needs, the structure here is suitably flexible allowing for specific needs of each individual and certain house rules are necessary for mine and others safety”. Residents’ personal files are held securely and staff demonstrated how they respected individual residents rights for privacy and confidentiality. Residents’ surveys confirmed that their rights and confidentiality were respected. One resident said, “Chandos is an excellent care facility and I feel privileged to be here. The staff and counsellors treat me like a human being and not an animal”. Three visiting professionals including a care manager from London, a student social worker (Bristol Criminal Justice Interventions Team) and a Senior Social Worker from Bristol Drug and alcohol team gave very positive responses. One commented “I find Chandos House to be exceptionally warm and friendly always providing the best care for my clients”. Chandos House DS0000026580.V296654.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 at least once during a 12 month period. 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 the service. Chandos House provides residents with the opportunity to engage in a rehabilitation programme, which helps them, prepare for a lifestyle that is free from drug and alcohol dependency. Meals are well managed and provide daily variation, good nutrition, life skills and social contact for residents. EVIDENCE: On the day of the unannounced key inspection the inspector found all of the residents in the private courtyard garden with the treatment manager, business development manager and the volunteer client liaison officer. They were about to start the day’s therapeutic programme with “Shintaido” which is a Japanese movement and freedom of expression that celebrates life. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 13 The inspector was asked to join in this event and other parts of the therapeutic programme that were taking place that day. This she did with the agreement of all of the group and a residents’ partner who was visiting. The inspector found the experience very beneficial in gaining a deeper understanding of what treatment and support are available to residents at Chandos. House. Following “Shintaido”, a community meeting was held. This weekly meeting allows residents to voice practical and emotional concerns, make day-to-day decisions together and plan other events. Residents have the opportunity y to act as house leader, deputy house leader and housekeeper as they go through the different stages of their treatment programme. Individual residents spoke about their week at Chandos House and the activities they had been involved with in the community, some residents were seeking agreement and support from the manager about visiting family in other parts of the country. One resident spoke about attending a family function, one resident spoke about voluntary work that he was engaged in and another resident spoke about the next event in which he was about to be the main participant. Discussion also took place about the communal lunch that a resident’s partner had prepared and the cookery event that was to be held that afternoon with the support and guidance of the volunteer. The next event held was called “Healing the family tree”. In theory this therapy allows residents to set up individual family constellations using other participants to help trace complex issues that influence family members. The inspector and one of the visiting relatives participated in this group, which was led and supported by the treatment coordinator who is a trained counsellor with some assistance from the current volunteer. All residents spoke positively about this therapeutic work and how much they gained from the support of other residents and staff. Communal lunch was held in the homes dining area. Residents, staff and visitors including the inspector all participated in this meal. Following lunch residents participated in a group event called Transformation speaking circles. This is a trust group in which participants sit in a designated chair and speaks about how they felt to get up and sit in the “honest chair “ and talk about their feelings for three minutes. Then one by one the other members have to say one positive thing about what they have heard. Then the participant in the chair has to say something they love, like or care about in themselves. Finally the group applauds. This is repeated for all participants. The inspector and visiting relative also participated in this group. All residents spoke highly about this group event and how it helped to raise their self-esteem. Following the community group and after each communal meal, a resident or participant in the group reads a daily meditation reading to the group from a non denominational book called “The language of letting go”. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 14 All residents consulted during the inspection spoke highly of the quality of the programme. They said that the therapeutic programme was demanding but agreed it was well balanced. The programme continues to be underpinned by group work and regular one-to-one sessions. This was confirmed by the visiting relative of one of the residents. Residents’ surveys comments included” I can talk to any member of staff. They are always ready to listen to what I have to say, I feel heard”. I would like it to be noted that Chandos has given me my life back and I feel that the environment is what a man needs to get his life back.” “ I would like to strongly state how essential Chandos has been in this development and progress as an individual. I cannot overstate the enormous healing I have experienced with in this house. I still continue to receive more from this experience.” Residents are encouraged to participate in team games at a local gym and are supported in accessing college courses and voluntary work with the support of their counsellor. During the inspection residents were seen going to the local gym to play team games such as badminton or squash, or returning from college where they confirmed that they have the opportunity get involved in a variety of courses. These include reading and writing skills, access to further education and learning a new language. In the first two weeks of the programme new residents can go out escorted by one of their peers. They also regularly participate in Alcoholics Anonymous and Narcotics Anonymous groups and other community projects including voluntary work. In agreement with counsellors and peers, residents’ families can visit as part of their recovery programme. The twelve-step programme and routine underpins the life of the home, but within this there is flexibility and a high degree of trust. There is an expectation of honesty about what people have been doing and how they are feeling which they share with other residents and their counsellors. There was evidence to confirm that staff use risk assessments where they feel it is necessary to do so. There are robust on-call arrangements when the home is not staffed during the evenings and at weekends. Residents said that they felt this encouraged selfresponsibility. Residents consulted confirmed the on call arrangements. One resident said that the telephone was programmed for automatic redial to the manager and that the call was free. The inspector heard if anybody relapsed a member of staff would ring to check everybody was ok and also that if there were any problems night they could ring the on call person for support. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 15 The kitchen is well equipped to meet the needs of those accommodated. The meals are planned and prepared by residents. All residents consulted with spoke highly of the catering arrangements and the high standard of food they ate. We take it in turns to buy the food and we always have a budget to buy fresh meat, fish and vegetables. This information was confirmed in the menus that were available for inspection. The main communal meal is in the evening and is seen as a time for all service users to get together and support each other about the day’s events. However as discussed earlier the inspector took the opportunity to participate in the communal lunch. The pasta meal had been prepared by resident’s relative as a special treat. Resident said “we take it in turns to clean, cook and tidy up. We learn how to be self sufficient at Chandos House”. This information was confirmed when residents were seen later in the day washing up and then preparing the communal evening meal of Chicken Korma and rice which was made with fresh ingredients. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ physical care and emotional health needs are fully met and support and counselling is delivered in a way that meets the individuals’ assessed needs. The medication administration system in place has improved considerably since the last inspection . The system in place now ensures that residents and staff are fully protected. EVIDENCE: Evidence confirmed that the home continues to have a positive relationship with the local GP who is willing to accept service users accommodated at Chandos House as temporary residents on his GP list. A very positive comments card was received from the GP who said that he had no problems with the home and that he was very satisfied with the care provided there. Very it was noted that contact with appropriate health professionals was made as required and detailed records were maintained about this contact. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 17 Positive comments were also received from a Community Nurse for alcohol services who said that she visited Chandos House and was very impressed with the pride they have in their work and the interest they invest in the clients. I was shown around Chandos informed about my client and confidentiality was respected at all times. Evidence confirmed that the Heath and safety executive are contacted when a resident sustains an injury inv the home or outside the home. The staff team were reminded about Regulation 37 notification and arrangements were made for an incident form to be completed on behalf of a resident who had sustained an injury outside the home following an accident’s Residents confirmed that they had been informed that staff at Chandos House reserve the right to request a urine sample from any resident suspected of using alcohol or drugs. Residents who are subject to a drug testing and treatment order are required to provide a sample at intervals specified by the court. Evidence confirmed that staff members carry out these tests sensitively. Very little medication is managed within the home unless a resident has a medical condition or requires homely remedies. A new medication cabinet storage facility was purchased following the last inspection which now complies with the legislation. All medication brought into the home is signed in and held securely by the staff team. Residents and staff sign for any medication administered by staff. A sample check of medication held was carried out and the records were noted to be up to date and accurate. Homely remedies held for staff are held separately from those held for residents. Following discussion with the business development manager it was the inspectors opinion that he would benefit from some medication administration training to help him with his role. . Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 18 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): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The complaints procedure in place is satisfactory with the result that residents have the detailed information they need to make a complaint. Systems in place to ensure that residents are protected from abuse are currently adequate. However further development of these systems must take place to ensure that the information in place is up to date and that residents are protected from risk of harm at all times. EVIDENCE: Residents confirmed that they are familiar with the complaints procedure. It is explained to them on admission. They also sign to say they have received this information. This information includes details of the Commission for Social Care Inspection and the response time for dealing with a complaint. The complaints information is now found in the in the statement of purpose and will be included in the service users guide which is in the process of being developed (as discussed in section one of this report). There have been no complaints received by the manager of Chandos House or The Commission for Social Care inspection since the last inspection. Residents consulted confirmed that they have the opportunity to raise any concerns at community meetings or one to one with the treatment manager or business development manager. One resident said complaints are normally brought to group and if appropriate sorted out there an then. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 19 The Business development manager demonstrated how a resident would be supported if an allegation of abuse was made and showed good awareness of who to contact in an emergency. Policies and procedures in place regarding the protection of vulnerable adults and “whistle blowing” are in place. Discussions took place regarding the Local Authority responsibility for Safeguarding vulnerable adults. Information was provided to The Business Development manager about Bristol City Council Safe guarding adults coordinator role and he was advised to contact her about ensuring Chandos House policy and procedure fully complies with The Department of Health Guidance No Secrets and also in respect of training in this area. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Chandos House continues to provide a clean, comfortable, safe home. EVIDENCE: The environment is well maintained and suited to residents’ needs. However there is currently no lift or accessible toilet facilities for disabled persons. The home has four levels with the lower ground floor accommodating the lounge/kitchen diner. Residents were seen using this area and looked comfortable and relaxed. Chandos House is decorated and furnished to a good standard which creates a comfortable homely atmosphere. All residents spoken with said that they valued this environmental standard and it helped them to “feel valued”. Communal rooms are tastefully furnished and attractively decorated. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 21 There is an attractive private garden/court yard area as well as a conservatory for service users. The conservatory is divided into two separate areas. There are computer facilities in one area for residents to access and the owner / responsible individual explained that she was refurbishing the other to make a quiet room for residents to enjoy which could also be used for one to one support. There are four shared rooms and two single rooms available in the home. The shared room is part of a programme of support when residents move into the home. As residents progress through the treatment/rehabilitation programme they move into a single room in preparation for leaving the treatment centre. Three-shared room were seen during this inspection. They looked homely and adequately equipped. They had been personalised with the two residents’ personal possessions. During the tour of the building it was observed that a number of repairs were due to take place in the home. Evidence confirmed that the maintenance work had been reported and that arrangements were in place for it to be completed later that week. The Business development manager confirmed the completion of the work a few days after the inspection. The toilet and bathroom facilities are sufficient to meet the needs of the residents. The home smelled fresh and the rooms were cleaned to a reasonable standard. The inspector was informed that there is currently only one cleaner for the home. She is currently on leave of absence but cleaning to the house was ongoing with residents’ involvement. The residents explained how they are encouraged to do cleaning and laundry themselves but a domestic assistants support them with these task. The house-cleaning day is held on a Thursday each week when all residents are expected to participate. A Community Nurse for Alcohol Services who had visited the home recently commented, “The surroundings were pleasant, clean and tidy. I would not hesitate to refer clients in the future”. Chandos House DS0000026580.V296654.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 at least once during a 12 month period. 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 the service. Following the last inspection the experienced, effective staff team remain under pressure due to a staff shortage. This situation needs to be urgently addressed to ensure that resident’s rights and interests are safeguarded and staff are well supported. The staff recruitment procedure has improved considerably since the last inspection. The systems in place ensure that all residents are protected at all times EVIDENCE: The home has a registered manager/ treatment coordinator (trained counsellor), a full time counsellor, a business development manager and a volunteer client liaison officer. The owner / responsible individual also works in the home every week day afternoon. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 23 Residents are usually provided with at least 1-hour 1:1 counselling per week, more if they wish and access to staff at any time during the day. However it was noted that there was ongoing pressure on the counselling service as the full time counsellor is still on long-term leave of absence and has been since before the last inspection conducted in March 2006.Consequently there is only one trained counsellor who is also the registered manager and has the responsibility to fulfil both roles with the support of the business manager and a volunteer. The volunteer has been in post since the last inspection. This post has developed since the last inspection and the volunteer is now known as the client liaison officer. There was evidence to confirm that the volunteer helps the manager / treatment coordinator with running groups and as discussed earlier in the report in the section on lifestyle the volunteer also provides cooking workshops to residents. Evidence confirmed that the volunteer shadow works at all times with another member of staff and is not left in charge. Both the counsellor and registered manager have diplomas in counselling and considerable experience in the field. They have regular professional independent counselling supervision, paid for by Chandos House. The business development manager, who has considerable experience in Social Care including management, explained that his role is to support the manager and counsellor with the administration of the home and reviewing all policies and procedures. He receives support from the registered manager and responsible individual. It was observed during this inspection that the registered manager has delegated the responsibility of day-to-day management of the home to the business development manager to allow him to take responsibility for the counselling and therapeutic programmes. This situation was discussed during the inspection. The registered manager is advised that he is still legally responsible for the management of the home. It was recommended that this Situation is kept under review. All residents consulted confirmed that they were aware of the roles and responsibilities of each member of staff. Evidence received during the inspection confirmed that despite the staff team being under pressure a good service continues to be provided to the residents of Chaos House. One resident said, “As a second stage treatment centre I feel that I am getting all the help and support I need. A lot of the work is very challenging but has a very positive affect. People who have known me from the past are delighted that I have got my life back on track and I am becoming more like my (good) old self. Personally I feel very fortunate to be in Chandos House.” Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 24 During this inspection evidence confirmed that the Business development manager is currently carrying out the day to day management tasks of the home which have been delegated to him by the registered manager. This situation was discussed at the time of the inspection. The Commission for Social Care have been kept to up to date by the owner / responsible individual regarding the staffing situation which has been under continuous review since the last inspection. Chandos House are registered with a Social Care Agency and the owner / responsible individual confirmed that a locum counsellor would be organised immediately if the registered manager could no longer provide this service. The inspector was informed that the counsellor who is on long-term leave of absence was now ready to return to work and a back to work assessment had been organised to take place in the next couple of weeks. It was recommended that details of the outcome of this assessment were sent to Commission for Social Care Inspection. As previously stated the home is not staffed at night or at weekends but there are robust support systems in place in the event of an emergency. The residents confirmed this The inspector viewed a sample of staff files including a new cleaner and it was noted that the majority of recruitment checks had been completed except a Criminal records bureau check for the member of staff who is on leave of absence. It was however noted that this check was in the process of being completed. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Chandos House is kept under constant review and development by the experienced management team, which ensures that the residents benefit from a well run home. The complaints procedure in place is satisfactory with the result that residents have the detailed information they need to make a complaint. The systems in place for the health and safety of residents and staff are not satisfactory. Urgent attention is required to ensure that there are safeguards in place at all times. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 26 EVIDENCE: The management of the home continues to work well with the support of the owner / responsible individual, registered manager / treatment coordinator business development manager and volunteer administrator who meet on a regular basis. However, as discussed in the staffing section there has been huge pressure on the staff team in particular the registered manager / treatment coordinator since the last inspection as a result of the full time counsellor being on leave of absence. The owner and responsible individual of the rehabilitation centre seen at the time of the inspection once again confirmed this situation and demonstrated how she was constantly reviewing the situation. Regular monthly reports of the owner /responsible individuals visit to the home are sent to The Commission for Social Care Inspection. It was noted that as part of the quality assurance system residents complete a survey at the beginning of their stay at Chandos House and then at six weeks and finally prior to leaving the home. A sample of this information was seen during this inspection. Samples of health and safety records were examined and it was noted that they were all up to date and accurate. Fire equipment checks and tests were noted to be up to date. Fire safety training and drills including residents are now taking place on a regular basis as recommended by Avon Fire Brigade. The fire risk assessment is in place and has been reviewed on regular basis. There was no written evidence to confirm that statutory health and safety training that all staff need to complete was up to date. The Business development manager was advised to conduct an audit on all staff including the registered manager to ensure that the following training is up to date: basic food hygiene, first aid (there must also be a qualified appointed first aider) and Health and safety training and that there is certificates in place to show when this training took place. Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 27 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 2 2 3 3 3 4 3 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 3 3 3 3 2 3 Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 28 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement An up to date service users guide must be in place and must be provided to all current and prospective service users. All gaps in information must be filled see NMS 1 This is an outstanding requirement from the previous two inspection conducted on 20th September 2005 and 25th January 2006 Following the back to work visit by the member of staff who is the full time counsellor a further review of the current staff shortage must take place to ensure that residents receive the counselling support as outlined in the statement of purpose. There must be staffing arrangements in place to ensure that the registered manager and Business development manager can take the holidays and time off they are entitled to as agreed in the job contact / terms and conditions Information about the action taken must be sent to the CSCI An audit of health and safety DS0000026580.V296654.R01.S.doc Timescale for action 31/08/06 2. YA33 18 30/08/06 3 YA42 18(1) 30/08/06 Page 29 Chandos House Version 5.2 training must be conducted on all staff /manager. This must include training on basic food hygiene, first aid and health and safety. Any gaps in training must be identified and training arranged. Certificates must be available for inspection 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 YA23 Good Practice Recommendations Arrangements should be made about to review Adult protection procedures in line with No Secrets legislation following discussion with Bristol City Council Safeguarding Adults Coordinator Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Chandos House DS0000026580.V296654.R01.S.doc Version 5.2 Page 31 - 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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