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Inspection on 28/05/09 for Chatterton Hey

Also see our care home review for Chatterton Hey for more information

This inspection was carried out on 28th May 2009.

CQC found this care home to be providing an Poor service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People using the service said the staff treated them with respect and were supportive. One person said, "I love this place. it`s brilliant. The twelve steps programme is helping me big time." Another person explained how well the staff were supporting him to work through the twelve steps rehabilitation programme. He said, " I`ve never looked back since l came here." Leisure activities were included in the rehabilitation porgramme. People using the service told the `expert by experience` that staff were more than willing to try and arrange any new activities they requested. Training for all members of staff was encouraged and provided by the Langley House Trust. The seven members of staff who completed the survey stated that they were given the training they needed in order to meet the needs of people using the service.

What has improved since the last inspection?

The following action has been taken to comply with requirements made at the last key inspection. Members of staff responsible for the administration of medication have received training. This helps to ensure that medication is managed correctly. Training courses in safeguarding vulnerable adults are arranged at regular intervals so that all members of staff receive this training. This helps to make sure people using the service are protected from abuse.

What the care home could do better:

Care plans should provide more detailed information about the healthcare needs of each person using the service. This will ensure that members of staff know exactly what to do to help people using the service to manage any problems with their health. Prompt action must be taken to improve the management of medication in order to prevent mistakes being made. A record of all medication received into the home must be kept. An accurate record of the administration of medication must be kept and if medication is omitted a reason for this must be recorded. To make sure people take the correct amount of medication at the right time medication administration records must provide clear and accurate information about the amount of medication to be given in one dose. To ensure people receive the treatment they need medication must be given to them as prescribed by the doctor. In order to prevent people from running out of their prescribed medication a system for reordering repeat prescriptions must be put in place. A risk assessment and care plan must be completed for each person using the service who self-medicates. This will ensure that the person is supported to manage their own medication safely. When controlled drugs are prescribed they must be stored in a legally compliant cupboard to prevent misuse and mishandling. Clear written instructions should be in place for staff to follow to ensure medication prescribed when required is given correctly. Handwritten instructions on medication administration records should be signed and witnessed to check that these have been copied correctly. All containers of medication should be dated when they are openedand the amount of medication left over from the previous month should be recorded on the new medication administration record. This will enable accurate checks to be made to ensure people using the service are given their medication correctly. To promote the safe handling of medication a system must be put in place to regularly check all aspects of the management of medication including staff competence. To ensure all members of staff know exactly what to do if allegations of abuse are made the procedure should be amended to state the correct action they must take.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chatterton Hey Exchange Street Edenfield Ramsbottom Lancashire BL0 0QH     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Hargreaves     Date: 2 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Chatterton Hey Exchange Street Edenfield Ramsbottom Lancashire BL0 0QH 01706824554 01706828761 Chatterton@langleyhousetrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Langley House Trust - Northern Regional Office care home 18 Number of places (if applicable): Under 65 Over 65 0 past or present drug dependence Additional conditions: 18 The registered person may provide the following category of service only: care home only - Code PC To people of the following gender : male Whose primary care needs on admission to the home are within the follwoing categories: Past or present drug dependency - Code D The maximum number of people who can be accommodated is: 18 Date of last inspection Brief description of the care home Chatterton Hey is a large detached property in its own grounds and is situated in Edenfield on the outskirts of Rawtenstall. The home provides a programme of rehabilitation and accommodation for up to 18 men recovering from substance misuse. This rehabilitation programme usually lasts from 6 to 12 months. The house is comfortable with domestic style furnishings and fittings. The accommodation reflects normal living as far as possible and both single and twin-bedded rooms are available. Communal rooms are spacious and a television, music centre and snooker table are available for residents to use in their free time. Residents and staff liaise with local educational services to provide for residents educational needs. Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home The current fee charged at Chatterton Hey is £525 per week. Additional charges are payable for personal items. A copy of the statement of purpose and service user guide is available to prospective service users and their relatives on request. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A key or main unannounced inspection, which included a visit to the home, was conducted at Chatterton Hey on 28 May 2009. As part of the inspection process we looked at all the information we have received about Chatterton Hey since the last key which took place on 4 June 2008. No additional visits have been made since the last key inspection. Information about the last key inspection can be obtained from Chatterton Hey or www.cqc.org.uk The manager completed an annual quality assurance assessment several weeks before this visit to the home. This document is a self-assessment that focuses on how well outcomes are being met for people who use the service. It also gives us some numerical information about the service. Care Homes for Adults (18-65 years) Page 6 of 33 Two completed surveys were returned from people using the service and seven from members of staff. At the time of this visit twelve people were living at the home. We were accompanied on this visit by an expert by experience. This is someone who because of their shared experience of using services helps the inspector to get a picture of what it is like to live at the home. We toured the premises and looked at staff files and care records. We spoke to members of staff on duty and people who use the service. Discussions also took place with the manager and deputy manager regarding issues raised during the inspection. The expert by experience had lunch with people using the service and concentrated on talking to them about the quality of food, leisure activities and the environment. His comments have been included in this report. What the care home does well: What has improved since the last inspection? What they could do better: Care plans should provide more detailed information about the healthcare needs of each person using the service. This will ensure that members of staff know exactly what to do to help people using the service to manage any problems with their health. Prompt action must be taken to improve the management of medication in order to prevent mistakes being made. A record of all medication received into the home must be kept. An accurate record of the administration of medication must be kept and if medication is omitted a reason for this must be recorded. To make sure people take the correct amount of medication at the right time medication administration records must provide clear and accurate information about the amount of medication to be given in one dose. To ensure people receive the treatment they need medication must be given to them as prescribed by the doctor. In order to prevent people from running out of their prescribed medication a system for reordering repeat prescriptions must be put in place. A risk assessment and care plan must be completed for each person using the service who self-medicates. This will ensure that the person is supported to manage their own medication safely. When controlled drugs are prescribed they must be stored in a legally compliant cupboard to prevent misuse and mishandling. Clear written instructions should be in place for staff to follow to ensure medication prescribed when required is given correctly. Handwritten instructions on medication administration records should be signed and witnessed to check that these have been copied correctly. All containers of medication should be dated when they are opened Care Homes for Adults (18-65 years) Page 8 of 33 and the amount of medication left over from the previous month should be recorded on the new medication administration record. This will enable accurate checks to be made to ensure people using the service are given their medication correctly. To promote the safe handling of medication a system must be put in place to regularly check all aspects of the management of medication including staff competence. To ensure all members of staff know exactly what to do if allegations of abuse are made the procedure should be amended to state the correct action they must take. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A thorough admissions procedure ensured people using the service were suitable for the rehabilitation programme. Evidence: A copy of the statement of purpose and service user guide is available to people who are considering using the service and their relatives on request. These supply information about the rehabilitation programme and the facilities provided at the home. The manager explained that people seeking admission to the home are required to complete an application form and provide information about their lifestyle including any offences they have committed. The manager or a senior member of staff then arrange to interview and assess the person to determine their suitability for the rehabilitation programme offered at Chatterton Hey. If possible this interview takes place at the home but if necessary the person would be visited in prison. Further information is obtained from drugs workers and other healthcare professionals. This Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: process ensures the health, social and drugs related related problems of people considering using the service are identified before they were accepted for the programme. A record of the pre-admission interview and assessment was seen in the files of two people using the service. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The involvement of people using the service in planning their care makes sure they are given the support they need in order to progress through the rehabilitation programme. Evidence: We looked at the individual care plans of two people who use the service. These plans provided detailed information about the care and support needed by each person to help them progress through the rehabilitation programme. People using the service were involved with developing their care plan and with help from their counsellor set goals and recorded the action they needed to take to meet their goals. People using the service signed the care plan to indicate their agreement with the support provided. The care plans were reviewed every three months with each person. This made sure the care plans were kept up to date with the changing needs of people as they progressed through the programme. Key workers and counsellors also supported people to make decisions about changes in their lifestyle that would aid their recovery Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: and help prevent a relapse. Appropriate risk assessments had been completed and risk management plans were in place. These plans gave clear directions for staff to follow about how to manage the risks associated with mental health problems, addictive behaviour and group activities. On admission to the home people signed a contract agreeing to keep the house rules and the restrictions these imposed as part of the twelve steps rehabilitation programme. These included not going out alone for the first few weeks, receiving visitors only by prior arrangement and attending individual and group therapy sessions. One person said, Ive never looked back since l came here. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The structured daily routine, therapeutic, educational and recreational activities provided helped people using the service to make progress through the rehabilitation programme. Evidence: Discussion with people using the service and members of staff confirmed that a structured daily routine was in place. This was compulsory for everyone and designed to help and and support people through the twelve steps rehabilitation programme. People using the service were required to attend group therapy sessions where a variety of issues were discussed. This included,Just for Today which was a meditative reading and reflection, relapse prevention, individual experiences and setting goals. In addition to this people using the service attended narcotics anonymous meetings on two evenings each week and some people also attended weekly meetings of alcoholics Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: anonymous. One person said,The twelve steps is helping me big time, l love this place and wouldnt want to be anywhere else. Household tasks and leisure activities were included in the daily routine. People using the service said they worked in teams to do the cleaning, cooking and gardening. Each person, in turn, was given the responsibility of being team leader. Some of the leisure activities organised were compulsory and designed to promote team building for people using the service. These included a walk one evening per week when the weather permitted and a weekly visit to the gym. Leisure activities available at the home included, snooker, darts, football, punch bag, table tennis, books and karaoke machine. Trips out to the cinema, bowling, Blackpool and other local amenities were also arranged. People using the service were allowed to choose what they wanted to do on Saturday afternoons and all day Sunday. One person explained that he was happy to abide by the rules. He also said that staff had taken him shopping in Bury and had allowed him as much time as he needed. The manager said that a few people who wished to practice their faith attended various local Churches on a Sunday. The expert by experience discussed leisure activities with people using the service and reported as follows; there seemed to be a lot of various activities taking place Monday to Friday including days out, small trips out and group work. One person said he had been on cinema trips, community based outings including walking and fishing. Overall it seemed very positive the staff were more than willing to try and accommodate new activity ideas anyone may wish to ask for. Residents enjoy the greenhouse and allotment they have on the premises in which they grow all different fruits and vegetables. it was not appropriate for people using the service to seek employment during the rehabilitation programme. However, voluntary work locally and further education was encouraged for people who were making good progress and had been at the home for more than three months. One person was doing voluntary work at a charity shop and another at an animal sanctuary. One person was continuing his education at a local college. The manager explained that visiting was only allowed by prior arrangement and usually only at the weekend. However, the manager was sensitive to individual and circumstances and would allow visiting at other times if necessary. On the day of this visit the meal served at lunchtime was fishcakes and chips. People using the service and members of staff ate their meal together in the dining room. Lunch was unhurried allowing time for people to chat and enjoy their meal. All the people asked said they enjoyed the meals. The expert by experience discussed meals Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: with people using the service and reported as follows; All residents have a rota around who cooks the meals on a weekly basis which enables them to continue with some everyday living tasks. Shopping is done through the internet and then its delivered to the home. After speaking with some of the residents it was clear they had a lot of input into shopping and residents really enjoyed doing it. It was brought to my attention that if residents do require something before the shopping day then there is a facility available to go to the local shops, if approved by a member of staff. Residents had no complaints about food. They said that it was lovely, especially to share the cooking. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were treated with dignity and respect. Serious deficiencies in the management of medication could put some people at risk. Evidence: Although people using the service had to comply with the house rules imposed as part of the rehabilitation they said that they were treated with respect. Care plans provided limited information about the healthcare needs of people using the service. The care plan for one person indicated that he suffered from epilepsy but there were no directions for staff about how this condition was managed or the action they needed to take if this person had a seizure. Another person suffered from diabetes but again there were no directions for staff to follow to ensure this person was supported to manage his condition properly. Having detailed care plans about healthcare promotes the health and well being of people who use the service. One person said the staff arranged for him to see the doctor when necessary. We looked at records for the management of medication and found that a record of Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: medication received into the home was not always made. We checked a sample of medication records and stock but found it difficult to account for some medication. This was because medication was not dated on opening and the amount of medication left over from the previous month was not recorded on the new medication administration record. Keeping detailed and accurate records help prevent the mishandling of medication. Hand written instructions on the medication administration records were not signed or witnessed by another member of staff to indicate that the instructions had been copied correctly. Some of these instructions were inaccurate and could be misleading. The instructions for one medication stated one to be taken twice daily, when instructions for this medication had been written again it stated, 2 x daily. The instructions written on another medication administration record stated the strength of the tablets but not how many should be taken in one dose. Not having clear written instructions for the administration of medication could result in mistakes being made which can seriously affect the health and wellbeing of people using the service. Records of medicines given to people were not always signed and there were numerous gaps on the medication administration records. If the medication had been omitted the reason for this was not recorded for example, if the person had refused. One person had been prescribed medication to be given once daily but records suggested this had not been given on three occasions recently. No reason for omitting this medication was given. The medication administration record for one person indicated that he had not been given the medication prescribed three times a day for two days the previous week. The manager said this was probably because the medication was out of stock. She was advised to make sure that repeat prescriptions were re-ordered in time to prevent people from running out of their medication. Going without prescribed medication can seriously affect the health and wellbeing of people using the service. One person was prescribed antibiotics to be given four times a day. The medication administration record showed that this person had only been given this twice a day on five days and once on two days. The amount of medication in stock confirmed that this person had received only twelve doses of this medication in the last ten days. Failure to ensure people using the service receive their medication as prescribed by the doctor can seriously affect their health and wellbeing. One person using the service was responsible for administering some of their own medication. However, a risk assessment had not been carried out to ensure this could be done safely. Moreover, there was no written guidance in the care plan for staff to Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: follow about the support this person might need or how they should check that medication had been taken correctly. A medication administration record was not in place listing the medication to be taken, the dose and the time to be taken. Some people using the service were prescribed medication to be taken when required. However, there was no written guidance for staff to follow explaining the symptoms each person might display when they needed their medication. Having clear written instructions for the administration of when required medication ensures people are given their medication only when they need it. The way members of staff recorded the administration of when required medication was inconsistent. Some members of staff signed the medication administration record and others recorded this on the back of the medication administration record. This was confusing and increased the risk of mistakes being made. Although controlled drugs were not currently prescribed the storage available for these was a cash box within the medicine trolley. This was not attached to the inside of the trolley so it was not completely secure. There was no evidence to suggest that the manager or a senior member of staff checked the medication to ensure this was being managed correctly. The manager was advised to develop a system for regularly auditing all aspects of the management of medication including staff competence. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints were taken seriously and investigated. Members of staff had limited understanding of the procedure to follow if allegations of abuse are made.. Evidence: A copy of the complaints procedure was displayed in the home and included in the statement of purpose and service user guide. The manager has investigated one incident using complaints procedure in the last year. This incident should have been investigated under safeguarding procedures. No complaints have been made directly to the Commission. Two people who use the service completed and both indicated that they knew how to make a complaint. The seven members of staff who completed the survey indicated that they knew what to do if a person using the service or their relatives expressed concerns to them. We looked at the policies and procedures for safeguarding vulnerable adults. The procedure about the action to take if allegations of abuse were made did not clearly state that social services must be informed before any investigation takes place. The manager was advised to amend this procedure to ensure all members of knew the correct action to take if allegations of abuse were made to them. Discussion with two members of staff confirmed that they had received training in safeguarding vulnerable adults. They both said they would report any concerns to the Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: manager immediately. However, they were unsure of the role of social services in deciding who would be responsible for conducting the investigation. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises provided a comfortable, peaceful and homely environment for people using the service. Evidence: A tour of the premises confirmed that the home was clean, tidy and well maintained. people using the service were given responsibility for all household tasks to help them develop the skills they would need to live independently. This included, cooking, cleaning and gardening. Furnishings and fittings were domestic in style and provided a suitable and homely environment for people using the service. The grounds and gardens were well kept by the people using the service. They also grew vegetables in the garden and a greenhouse. People using the service were also responsible for doing their own laundry. A suitably equipped laundry room was available for this purpose. The expert by experience reported; Chatterton Hey is a very clean hygienic environment with a very welcoming homely feel. In the first stage of rehabilitation people are required to share bedrooms. In the second stage they have more individual Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: facilities for example their own bedroom. The two people using the service who completed the survey indicated that the home is always clean and fresh. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Members of staff are encouraged to acquire the skills and knowledge necessary in order to meet the needs of people using the service. Recruitment procedures are thorough. Evidence: The duty rota provided details about the grades and number of staff on duty for each shift. Two people using the service completed the survey and in answer to the question are staff available when you need them, one responded always and one usually. Within the last year staffing at night has changed from the member of staff on duty sleeping to being awake throughout the night. The manager or team leader was on call during the night in case of emergency. People using the service told the expert by experience that it was very important to them to have a member of staff on duty and awake throughout the night. They also told the expert by experience that members of staff were very friendly, helpful and approachable. Trained counsellors were also employed at the home. They were responsible for running group therapy sessions and for providing counselling individually to people Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: who use the service. These sessions were a vital part of the twelve steps rehabilitation programme. We looked at the files of three members of staff appointed since the last inspection. These files indicated that all the required information had been obtained before they had started working at the home. These included two written references and a Criminal Records Bureau check. These checks ensure people who use the service are protected from the employment of unsuitable staff. Discussion with members of staff and the manager confirmed that training for members of staff was encouraged. This included induction training for new employees, fire safety, safeguarding vulnerable adults, health and safety, basic food hygiene, medication and first aid. In addition to this one support worker had a National Vocational Qualification level 3 in health and social care. This included units about substance misuse. Three more support workers were working towards this qualification. The seven members of staff who completed the survey indicated that they received the training they needed to help and support people using the service. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a competent manager and is run in the best interests of people recovering from substance misuse. Evidence: The registered manager is experienced in supporting people recovering from substance misuse. She maintains an up to date knowledge of current practice by attending meetings with providers of similar services where they share knowledge and best practice. She also uses the internet and reads a variety of care journals. The manager explained that the views of people using the service were obtained during monthly visits from a senior manager within the company. The Langley House Trust arranged regional conferences and an annual national conference to which representatives of people using the service were invited. People using the service were also asked to complete anonymous satisfaction questionnaires every year. These were evaluated at head office and the manager informed of the outcome. As a result of listening to people using the service trips out were arranged every month. The Annual Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: Quality Assurance Assessment stated that the daily meeting to look at the diary and discuss any problems was changed from after breakfast to 4pm. Policies and procedures for safe working practices were in place. These help to make the sure the home is a safe place to live and work. Fire alarms were tested weekly and emergency lighting monthly. An up to date fire risk assessment was available and fire drills were held every three months. We looked at the records of routine servicing of equipment. These included an up to date electrical installation certificate and evidence that the testing of small electrical appliances was carried out annually. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 24 A system must be put in place to regularly audit all aspects of the management of medication including staff competence. This will ensure medication is managed safely 31/07/2009 2 20 13 The medication administration record must give clear and accurate information about the medication prescribed including the strength of the medicine and the amount to be given in one dose. Medication must be given to people as prescribed by the doctor. A system must be put in place for for the prompt ordering of repeat prescriptions. A risk assessment and care plan must be completed for 26/06/2009 Care Homes for Adults (18-65 years) Page 30 of 33 each person using the service who self medicates. This will ensure people take the correct amount of medication at the right time. Not giving people their medication can seriously affect their health and wellbeing. This will ensure people who use the service do not run out of their prescribed medication. This will ensure the able and supported to manage their own medication safely. 3 20 17 A record of all medication 26/06/2009 received into the home must be kept. An accurate record nust be made of the date and time medication is administered to each person using the service. If medication is omitted a reason for this must be recorded. This will enable medicines to be audited to make sure they are being given correctly. This will ensure people receive their medication at the correct time and help prevent mistakes being made. Care Homes for Adults (18-65 years) Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 18 20 Care plans should include more detailed information about the healthcare needs of people using the service. Clear written instructions should be in place for staff to follow to ensure medication prescribed when required is given correctly.Clear written instructions should be in place for staff to follow to ensure medication prescribed when required is given correctly. Hand written instructions on the medication administration records should be signed and witnessed. This ensures that instructions have been copied correctly. All containers of medication should be dated when they are opened. The amount of medication left over from the previous month should be recorded on the new medication administration record. This will ensure medication is managed correctly and enable accurate checks to be made. The procedure for safeguarding vulnerable adults should be amended to clearly state the correct action that staff must take if allegations of abuse are made. 3 20 4 20 5 23 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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