CARE HOME ADULTS 18-65
Closereach George Lane Plympton St Maurice Plymouth PL7 3LJ Lead Inspector
Mandy Norton Unannounced 2 September 2005
nd 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 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 Stationary 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. Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Closereach Address George Lane, Plympton St Maurice, Plymouth, Devon, PL7 3LJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01752 348348 01752 347555 Broadreach House Mr Gerard Dooley Care Home 17 Category(ies) of Past or present alcohol dependence (17), Past or registration, with number present drug dependence (17) of places Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Male only Age 18yrs Date of last inspection 27.10.04 Brief Description of the Service: Closereach House is a registered charity providing a range of services in Plymouth for the treatment of alcohol and drug dependence. Closereach is a 17 bedded registered facility for continued treatment (post ‘first stage’ detoxification) for drug and alcohol dependence for males over 18 and up to the age of 65, the normal length of stay is 6 months. The house is situated in Plympton St Maurice and is arranged on 3 floors. The ground floor consists of offices, the dining room and 2 lounge areas that are also used for group meetings. The first floor has the Service Users accommodation and bath and toilet facilities. The top floor has offices and an area that can be used as a meeting room. The home employs a manager ,a team of counsellors to run the programmes of care designed for the Service Users and other support staff ensure the home runs effectively on a day to day basis. Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 3 hours and 10 minutes and was conducted with the acting manager. Residents were involved in therapeutic activities during the inspection so were not spoken with on an individual basis. What the service does well: What has improved since the last inspection?
The one recommendation made at the last announced inspection in October 2004 to replace mirrors in the washroom/toilet area has been met. The home has made steady improvements over the last few years to have now reached the point where the home has received no score below ‘standard met’ (3)and has been awarded an ‘above the standard’ (4) score for four standards during this inspection.
Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 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 standard(s) 2, 3 and 4 The information provided to prospective residents enables them to make an informed decision about admission to the home. EVIDENCE: The home carries out a thorough admission assessment process before admission is agreed, involving both consultation with the care manager and a meeting or phone contact (if possible) with the prospective resident. An assessment pack is sent to the care manager and the prospective resident, some of which is completed before admission and some during the trial visit (if one is able to be carried out). A general risk assessment is carried out for all prospective residents. The pre admission process is of a high standard. The information provided to the prospective resident clearly states the purpose, duration and requirements of the programme, including any restrictions of liberty and grounds for discharging a resident. Trial visits to the unit are encouraged and the prospective resident can stay overnight to assess the service offered. This also gives the staff the opportunity to see how the person will fit in with existing residents. Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 The delivery of resident’s care and treatment is well detailed in their individual care plan and risk assessments. The residents quality of life, whilst in the home, is improved by having as much freedom and choice as possible, within the restrictions of the treatment programme. EVIDENCE: The home has a general care and treatment plan which identifies the areas of need and to direct both support workers and counsellors to address these needs. The plans examined during the inspection were complete and up to date. Risk assessments in place clearly show that identified risks had been acted upon. The active use of risk assessments to enable residents interests to be protected is excellent practice. Residents are also supported/ encouraged to manage their own daily routines and personal decision making within the restrictions of the treatment programme. During a tour of the home residents were seen engaged in a variety of individual and group activities. Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14 and 17 Residents have a variety of leisure activities to ensure a good quality of life while living at the home. Residents have considerable access to opportunities for personal development, which will help during and after the treatment programme. Dietary needs of the residents are well catered for with a balanced and varied selection of food available that meets the residents tastes and choices. EVIDENCE: The acting manager described a variety of activities that the clients have undertaken recently including trips to an open air theatre, use of the local leisure centre and gym and unaccompanied trips to Plymouth (especially in the 2nd half of the treatment programme).The clients are given free bus passes for travel within Plymouth at arrival in the home. This helps them to access facilities and services in the city including NA/AA. Within the home the residents watch DVD’s and relax together. The acting manager stated he is hoping to get a new computer for residents to learn how to write music.
Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 11 Later in the programme the residents are able to undertake work via the volunteer bureau and includes helping at St Lukes Hospice, the Joshua Reynolds centre and helping the maintenance team working for Broadreach. The resettlement officer is able to help residents to feed into educational opportunities and get help with literacy and numeracy skills. Closereach continues to provide good quality food with good variety. There is regular consultation with residents taking into account their preferences and special dietary needs. The cook likes to involve the residents in mealtimes and supports them in learning new cooking skills and techniques. The residents enjoy the food and have sufficient quantity. Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 20 Residents health is maintained by meeting their personal care needs and by well managed administration of their medication. EVIDENCE: Residents at Closereach have minimal personal care needs. Should support be needed this is available from the counsellors and support workers. Observing the residents during the inspection it is clear that they are able to maintain their own ‘style’ that reflects their personality. Self-administration of medication is restricted in the home. Some inhalers and vitamins are managed by the residents themselves The amounts of medication being prescribed to clients is maintained at a low level and is monitored regularly. The homes medication storage facility is appropriate for the homes needs. Staff are currently undertaking a medication management course. Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Complaints are properly managed by the organisation protecting the welfare of the residents. EVIDENCE: The complaints procedure is clearly displayed in the home, and is attached to the service users guide (which is given to all residents entering the home). Details of how to contact the CSCI locally are clearly stated in the procedure. The Broadreach organisation has developed a new ‘protection of adults at risk’ policy, which clearly states how an allegation or disclosure of possible abuse would be managed. Awareness of abuse is a central part of counsellor’s clinical training and new support workers induction. Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,27 and 30 The residents benefit from a comfortable, clean and well maintained home that meet their needs. EVIDENCE: A tour of the home confirmed that he quality of the living environment and the standard of decoration in the home is generally good. The home was clean and odour free. The residents do the cleaning within the home as part of their ‘therapeutic duties’ and make a very good job of it. The availability of useable space in the bedrooms is adequate to meet the needs of the residents (most rooms are multi occupancy). Personalisation of rooms is also limited because of the short stay nature of the service, however residents have made the rooms as homely as possible. None of the bedrooms have locks due to the needs of the treatment programme. The toilets and showers were in good condition, mirrors that were in a poor condition during the last inspection have been replaced. Some of the carpets in the home are showing signs of wear and will need replacing in the near future. Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33 and 35. Resident’s needs are met by enough competent and qualified staff. EVIDENCE: There is currently an acting manager running the home and a decision about whether is to register as the homes manager will be made in the near future. Over the past year all staff have received, all of the mandatory basic training, and fire awareness training. All staff will undertake safe handling of medication in the near future. Specialist training is also undertaken to ensure the staff have a variety of skills to meet the needs of the residents. The home is staffed in order to meet the needs of the residents and has no night staff, although the manager or a counsellor are on call at all times. This is regularly reviewed as the client group changes. The staff work closely with certain residents to help them through the second stage of treatment. Regular staff meetings take place to discuss a variety of issues including the treatment programme. Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 41 and 42 The management of the home is effective and continues to develop the quality of the service so that clients needs continue to be met. EVIDENCE: Good working relationships were seen between the counsellors, residents, support staff and the acting manager. The records seen during the inspection were well maintained and stored appropriately and securely.. Health and safety is well managed in the home with some of the residents helping the estate team with maintenance tasks throughout the Broadreach Trust. Statutory training including fire safety and food hygiene has been carried out to ensure the safety and welfare of the residents. Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 4 3 3 x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 4 x 4 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x 3 x x 3 Standard No 11 12 13 14 15
Closereach 4 3 3 3 x Standard No 31 32 33 34 35 36 Score x 3 3 x 3 x
Version 1.20 Page 18 D52-D04 S3532 Closereach V246117 020905 Stage 4.doc 16 17 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x x 3 3 x Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 19 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Closereach D52-D04 S3532 Closereach V246117 020905 Stage 4.doc Version 1.20 Page 20 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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