Inspection on 14/10/05 for Connect Community

This inspection was carried out on 14th October 2005.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Connect Community 28/02/08

Connect Community 22/02/07

Connect Community 22/03/06

Connect Community 21/03/05

Connect Community 27/11/04

Connect Community 24/02/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

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

CARE HOME ADULTS 18-65 Connect Therapeutic Community 19-21 Park Road Moseley Birmingham B13 8AB Lead Inspector Jill Brown Announced 14 October 2005 th 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. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Connect Therapeutic Community Address 19-21 Park Road Moseley Birmingham B13 8AB 0121 449 2204 0121 449 6124 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) Connect Therapeutic Community Ltd Jenny Robinson Care Home 10 Category(ies) of Mental Disorder (10) registration, with number of places Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home can provide care and accommodation for up to 10 service users of either gender between the ages of 18-65 years of age suffering with a mental health problem (MD). Date of last inspection 21st March 2005 Brief Description of the Service: The home is situated south of the city centre and lies close to a frequent bus service into Birmingham. The property is part of a large Victorian terrace, and is similar in appearance to others on the road. The building has been adapted throughout its history and has several corridors, stairways and changes of level inside. There are two front doors, only one of which is in general use, and this is accessed via a walled and gated front. There is a garden to the rear of the property, which contains a greenhouse, some lawned and flower areas and a laundry. Office spaces, lounges, therapy rooms, a kitchen and dining room are found on the ground floor. There is a mixture of double and single rooms on the first and second floor. Toilet and bathing facilities are communal. The home provides care and support for up to ten people with mental health issues. The mission statement for the home states. ‘We are a therapeutic community providing high quality residential and non-residential psychotherapy for clients and support services to professionals working with them. Using Transactional Analysis as our main framework, we provide therapy for psychological, emotional or behavioural problems in order to promote life long, sustainable improvement to that individual’s quality of life.’ Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector visited Connect for an announced inspection in October. The inspection included talking with all of the service users in a group, talking with 2 care staff as well as discussion with the managers. Two service user files and two staff files were viewed. Fire safety records, gas and electrical safety certificates were looked at. The medication administration process was looked at but not audited. Five comment cards were received in total one from a health professional and the rest from service users. The Commission wishes to apologise again to service users for the wrong comment cards being sent. What the service does well: Thorough assessments of potential service users are carried out prior to admission. These assessments include information from associated health and social care professionals. Service users spend time at Connect prior to admission and are able to make the decision about whether it can help them. Comment cards from service users said that Connect ‘felt like a family’ and ‘like my own home.’ Connect provides information about the running of Connect, including restrictions that may be imposed to ensure the safety of individuals. Staff were approachable and clinicians were available if the need arose. Staff were aware of the interests and hobbies of service users and where possible service users were helped to further these. Meals take place in a relaxed atmosphere and mealtimes are seen as a point when service users and staff can have social conversation as a well-being check. Medication administration was good however the current system may come under pressure as more service users are admitted. Connect has a weekly meeting for service users to raise issues these are recorded and outcomes noted. Service users knew how to make complaints and felt safe to do so. Staff had training on the management of aggression, were able to recognise signs of difficulty and knew how to intervene quickly. Staff knew the Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 6 importance of good communication with service users. A service user commented that they did not feel ‘got at’ in Connect. The building was clean, fresh and well furnished. 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. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 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 Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 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) 1,2, 3, 4 &5 Information provided for service users was clear. Arrangements for assessment and trial stays at Connect were good. This ensures that service users can make an informed choice about staying at Connect therapeutic Connect. EVIDENCE: Connect therapeutic Connect has provided the Commission with a copy of their Statement of Purpose and Service User guide. These documents provide useful information and are clear about where there are restrictions for clinical or health and safety reasons. The inspector did not ask the service users about whether they received this documentation on this occasion. Before being admitted into Connect, service users have a thorough assessment over several months and also spend some time usually about three days at Connect before the decision is made to offer a place. The assessments include information from other sources such as social care and medical assessments. Highlighted in these assessments is a history of service users’ risk behaviour and plans are made to minimise these risks and these are called ‘structures’ at Connect. Connect does not take service users on an emergency basis without a full assessment. Staff interviewed were aware of the plans for individual service users and showed knowledge of service user’s interests and behaviour. Service users said that staff were generally available, helpful and supportive. It was clear Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 9 that some service users had made a big effort to ensure that they could receive the benefit of this service. The length of stay of service users can cause tension with funding authorities and be of concern to the service user as funding authorities not wishing to commit more than six months funding at a time. Connect has developed a contract with the service user. Some rewording of the contract was needed about placements breaking down due to risks to other service users. This rewording may assist some problems funding authorities had to signing up to the contract. Funding arrangements were clear and evidenced on service user’s files. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 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 standard(s) 6,7,8,9,10 Arrangements for care planning were good and responded to changes in both identified risks and service users well-being. Service users were consulted regularly and these arrangements meant that service users felt well supported. EVIDENCE: The service user files sampled had evidence of a care plan and a therapeutic plan. General restrictions in freedoms were outlined in the home’s Statement of Purpose and an explanation given. Connect also had rules for communal living and individual safety of service users. These rules were revised through the meetings with service users in the home. Service users said that the rules had helped as the numbers in Connect had increased since the last inspection. Individual service users had structures as part of their care plan that changed as residents needs and risk level changed. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 11 It was clear from care plans that Connect were beginning to respond to difficulty in gaining long term funding for service users by setting some timed goals. Service users were well aware of any structures that were in place for their safety as part of a risk management strategy. Connect has individual strategies for service users that go missing and informs the Commission appropriately. Connect has clinicians that work with individual service users on a routine basis as well as being available for issues as they arise. It was clear that if needed these clinicians could be called in at any time. Service users were allowed to manage their own money but equally were assisted where needed and requested. Service users can opt for information, such as if they go missing, to be shared with relatives. Connect has some new confidentiality procedures and a copy of this is to be sent to the Commission. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 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 standard(s) 12, 13, 15, 16, 17 Arrangements for meals, visits from relatives and preservation of service users’ rights were appropriate to the service and needs of the service users. Service users access to leisure facilities external to Connect needed improvement. EVIDENCE: Service users of this Connect receive support to access Connect support safely. However as the number of service users has increased and new service users require extra support it has restricted choices on an evening and at weekends. For example it is usual for new service users to have structures that prevent them going out of Connect alone, if only two staff are on duty it is not possible to free the member of staff to take the person out. Connect has tried to put more staff on a sessional basis but this has not worked well. Service users thought that the level of support available had lessened since the last inspection. Service users were admitted into Connect to undertake therapeutic treatment to assist with emotionally difficult or traumatic period in their life. Service users have been encouraged to take on employment and attend college when Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 13 this was appropriate but the therapeutic element of their care was key reason for admission. The homes statement of purpose and has goals for all service users to achieve in independent living through their therapeutic process. Service users were allowed visitors and, friends and family can visit Connect as long as this was positive for the service user. The home has areas where service users can meet with visitors in private. Service users rights, responsibilities and daily routines are negotiated and sometimes set by the therapeutic plan that the individual service user is on and the risks they may present. So for example the amount of time service users can spend alone in their bedroom is restricted because of the risks of self-harm and because of withdrawal from the therapeutic Connect. These restrictions are clear in the rules of Connect and specific structures are in place if required for individuals. Meals are organised and prepared by service users. Meals are taken with staff in a relaxed atmosphere. Connect has the services of a fitness trainer that gives advice to service users on diet and exercise. Service users have various domestic tasks within Connect and a comment was received about the amount of these tasks. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 14 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, 19, 20 The arrangement for medication administration was good and this protects service users. Health and social care needs were met and this meant service users felt supported. EVIDENCE: Connect does not have service users that require support with their day-to-day personal care. Service users believed that they well supported although they recognised the emotional work that they undertook was sometimes difficult. Services users are given support to attend the GP or hospital if they request this support. Service users emotional well-being is checked on a regular basis throughout the day. Connect administers service users’ medication because of the risks involved. The system of medication administration was good but in the inspectors opinion could become unwieldy the more service users that are admitted. It was not normal practice for 2 staff to clerk in medication and this must be done and signatures kept on the Medication Administration Record (MAR). The MAR did not show the amount of medication at the beginning of each record and was not being used as a primary audit tool although records were being kept separately. Staff had received training in the safe handling of medication. Improvements that would assist administration are: -a 28-day cycle for Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 15 medication for all service users and checking with the GP whether one medication given at unusual time was safe to administer during Connect’s usual timed medication round. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 16 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, 23 Service users felt that their views were listened to and were clear about the complaint processes. Connects procedures protect service users from abuse. EVIDENCE: Service users were clear about whom they would complain to if they had concerns. They saw the weekly meeting as a forum to express issues and thought they were listened to. Connect keep a record of this meeting and outcomes of discussions. The service users also named another person they would go to if they had concerns about the manager or clinical practices. Connect has rules in place to protect the vulnerability of service users in residence. Connect is aware of the potential for aggression in Connect. Staff spoken to were able to describe signs of potential problems and how they intervene early. Staff have had recent training in adult protection and abuse. Service users commented that they felt safe and not ‘got at’, ‘it is like my own home’ and ‘it feels like a family and not an institution.’ Connects policies on bullying and cross gender and intimate care were not inspected on this occasion and these requirements were brought forward. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 17 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 The property provided a clean, safe and homely environment for the service users. EVIDENCE: The environment of Connect was not inspected on this occasion however the areas that the inspector saw were clean, fresh and well appointed. Connect had reduced its registration to ten service users since the last inspection. This level of service users improves the communal space available. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 18 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, 35 & 36 Staff training had improved since the last inspection and this ensures the safety of the service users. Arrangements for supervision of staff needed to be improved to ensure that a consistent response is given to service users. EVIDENCE: Service users thought staff were approachable and would listen to them. Talks with the staff showed that they had knowledge of the service users and issues that affected them. It was clear that the staff were aware of the importance of communication and shared understanding with service users. Staff have had up date training on key areas such as fire, moving and handling, first aid and risk assessments. Both staff had training in management of aggression techniques. Connect has put forward an outline for training to substitute for a NVQ 2, which may be more appropriate for the service Connect provides. Staffing at Connect needs to be reviewed in line with the increasing number of service users. Connect has yet to ensure all staff have had equal opportunities training from a disabled trainer. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 19 Staff are supervised weekly but this is not recorded and focuses on specialist supervision indicated by the service users’ needs. To meet the requirements and to further the employer elements of supervision a different meeting with the manager is required 6 times a year. Some policies and procedures had been altered and these were to be sent to the Commission. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 20 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) 42 The health and safety of service users was protected by Connects arrangements for maintenance and inspection of services such as electric and fire safety. EVIDENCE: Fire records showed that there were the required tests, inspection and maintenance of fire equipment such as fire extinguishers and fire alarm. Connect has appropriate inspection certificates for the gas and electrical equipment and the hard wiring. Connect informs the Commission of any accidents and incidents that occur. There is a monthly visit on behalf of the providers and reports of these visits are routinely sent to the Commission. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 2 x 3 3 x Standard No 31 32 33 34 35 36 Score x 3 3 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Connect Therapeutic Community Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 22 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 YA13 Regulation 18(1)(a) Requirement The registered manager must ensure that the staffing levels reflect the service users need for support in outside activities. Bullying procedure must be expanded to include information on forms of bullying and strategies or procedures to be followed once this as been identified. Timescale for action 31/12/05 2. YA23 12(1)(a) 13(4)(c) 31/01/06 3. YA31 15(2)(a) 4. YA35 18(1)(c) The home must produce an intimate cross gender care policy. These policies were not inspected and this requirement was brought forward. The home must ensure that 31/01/06 service users are clear as to what records regarding themselves they are able to have access to, and make such records available to service users at their request. The development of an access to records policy would clearly assist in this process. (this requirement was not assessed and was brought forward) Staff at the home must 31/01/06 Version 1.40 Page 23 Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc (i) 5. YA35 18(1)(c) (i) 6. YA36 18(2) undertake disability awareness training. The Commission and Connect 31/12/05 must continue to work on the proposal for training to replace NVQ2 care training to make it relevant to the service. All staff must have, in addition to 31/12/05 specialist supervision, recorded supervision at least 6 times a year that reviews performance, training and development. (this requirement was outstanding since the 31/05/05) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA5 YA20 Good Practice Recommendations It is recommended that the contract Connect has developed is adjusted to reflect practice when placements break down. It is recommended that the current medication process is reviewed taking into account the increased numbers of residents. It is recommended that the Medication Administration Record (MAR) chart becomes the primary tool for recording amounts of medication. It is recommended that two staff check and sign on the MAR that medication numbers, names, dosage and times are correct. Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Connect Therapeutic Community E54 S16863 ConnectCommunity V246501 141005 AI Stage 4.doc Version 1.40 Page 25 - 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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