Inspection on 01/08/06 for First Step

This inspection was carried out on 1st August 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

First Step 03/07/09

First Step 20/08/07

First Step 25/10/05

First Step 17/05/05

First Step 17/11/04

First Step 12/05/04

Similar services:

Park House

Huntercombe Centre

Wellburn House

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

CARE HOME ADULTS 18-65 First Step 114 Marton Road Middlesbrough TS1 2DY Lead Inspector Jane Bassett Key Unannounced Inspection 1st August 2006 09:30 First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service First Step Address 114 Marton Road Middlesbrough TS1 2DY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01642 231476 01642 232239 Endeavour Housing Association Mrs Gail Starling Care Home 15 Category(ies) of Past or present alcohol dependence (15), Past or registration, with number present drug dependence (15) of places First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th October 2005 Brief Description of the Service: First Step is housed in a large detached, converted vicarage, with some purpose built flats adjoining it, which have been taken over by the home. There is a small garden to the front of the property, and a private paved area to the rear where service users can sit outside. It is situated on a busy main road close to Middlesbrough town centre, so is convenient for services required by the service user group. Accommodation is provided for fifteen service users in thirteen single bedrooms (seven with en-suite facilities) and one double room. Of these rooms, three were under size requirements. However, the flats were spacious, with each service user having their own kitchen, bed sitting room and bathroom. These were used by service users who had completed the first two stages of their rehabilitation programme, and were progressing towards eventual discharge. There are two lounges and a large dining/activity room as well as a counselling room in the main building. The service users use both the kitchen and the laundry. The home offers a programme of rehabilitation that may include a period of detoxification for both drug and alcohol dependencies. Fess charged by the service range from £397.69 to £456.30. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection report includes information obtained from a pre inspection questionnaire, and an unannounced visit carried out by two inspectors. During the visits, which lasted a total of five hours the inspectors carried out a tour of the environment, an audit of documentation including staff records and residents files, and spoke to six residents, two staff members, and the manager. What the service does well: What has improved since the last inspection? What they could do better: Documentation in relation to the recording of controlled medication must be made more robust to provide a clear audit trail of all medication prescribed to residents, stored by and administered within the home. Advice must also be sought from the prescribing GP and pharmacist in relation to the crushing of medication. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 6 Work should continue to improve the environment of the home. 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. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome is Good. This judgement has been made from evidence gathered both during and before the visit to the service. Admissions to the home only take place if the service is confident staff have the skills and ability to meet the assessed needs of the prospective resident. New residents are provided with a statement of terms and conditions that gives a clear understanding of the agreements made. EVIDENCE: During the inspection five residents files were examined. These were found to contain evidence that the home carries out a pre admission assessment, including input from professionals involved in the care of the prospective resident. The manager told the inspectors that the home considers the needs of individual residents and how these are to be met prior to any admission. The inspector was told that the assessment documentation used by the home is being developed to include additional health information. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 9 Evidence was seen that indicated all residents had signed a licence agreement that included terms and conditions of the service and information on the restrictions on their liberty and freedom of movement that are necessary for participation in the treatment programme. Residents who spoke to the inspector confirmed this. Licence agreements contained details of the circumstances under which service users would be required to leave the premises. The home has a policy on discharge of residents. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9. Quality in this outcome is Good. This judgement has been made from evidence gathered both during and before the visit to the service. The plan of care is reviewed regularly involving the resident. It is updated and action taken to respond to changes. EVIDENCE: During the inspection five resident files were examined. These were found to contain information with regard to the care plan for each stage of the programme of rehabilitation. However these would benefit from inclusion of additional information in relation to the emotional and psychological support offered to individuals. The manager told the inspectors that work has been carried out to develop plans of care to include this information plus additional details on health care. One plan seen included a planned programme in relation to anger management, however this did not contain dates. Therefore it was difficult to ascertain if this programme was currently being followed or had been suspended. The manager has supplied the inspector with an updated plan in relation to this. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 11 Daily recordings were seen to be current and included a number of entries per day. Other records seen included key worker reviews that reflected changing needs, wellbeing and goals of the individual resident. The risk assessment process is commenced prior to admission and continues throughout the rehabilitation programme which promotes and works towards independent living. The home has connections with and access to outside organisations such as Alcoholics Anonymous. Residents who spoke to an inspector commented on the support they receive. Comments included ‘staff will help you, but not do it for you’ and ‘this is a good place’. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, & 17. Quality in this outcome is Good. This judgement has been made from evidence gathered both during and before the visit to the service. The service has a strong commitment to enabling residents to reach their goals and develop independent living skills. Residents are involved in all aspects of daily living at the home. EVIDENCE: Due to the nature of the rehabilitation programme provided by the service, considerable restrictions are placed upon the residents especially within the first six weeks. During this period residents can only go out into the community accompanied by a member of staff. This has an impact on the activities that are accessible to residents. As residents progress through the programme time away from the home unaccompanied is increased, giving access to the gym, community programmes ect. There is limited access to television and a computer. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 13 Daily routines are set and agreed by the residents as part of the programme, this includes restrictions on freedom of movement both within and outside the home, visits and contact with families and friends. Programmes of care include details of individual residents increasing responsibility for their daily lives. Residents are involved in the planning and preparation of all the meals served at the home. First Step DS0000000065.V305221.R01.S.doc Version 5.2 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 the following standard(s): 18, 19, & 20. Quality in this outcome is Adequate. This judgement has been made from evidence gathered both during and before the visit to the service. Residents are supported and helped with both physical and emotional health care promoting their independence and well-being. EVIDENCE: As well as general support of the staff the home provides a key worker system to offer residents support from a named individual. All who spoke to the inspector were clear as to who their key workers were. Residents who spoke to the inspectors said they felt supported by the staff throughout the programme. One resident spoke of the help staff are giving him/ her to move on. Another stated ‘ I get a lot of support with changing mood and lifting your spirits when feeling down’. A resident told the inspector of the courtesy displayed by staff when dealing with a personal issue. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 15 Residents who spoke to the inspector confirmed that that support included access to medical services as necessary. A resident told the inspector staff had enabled him / her to see a dentist, stating ‘ I have been trying to get a dentist for six years and they got me an appointment within one day’. An audit of medication was carried out. This identified no major concerns with ordering, storage and administration of medication. The home has developed medication administration records that include resident’s signatures as confirmation of administration. The recording of controlled medication was found to be limited and confusing, this must be made more robust to give a clear audit trail of medication received, stored and administered. The manager showed the inspector a controlled medication register that has recently been purchased and is to be used by the home. Advice must also be sought from the prescribing GP and pharmacist in relation to the crushing of medication. Information given to the inspector indicated staff who administer medication have received training in relation to safe handling of medication. First Step DS0000000065.V305221.R01.S.doc Version 5.2 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 the following standard(s): 22 & 23. Quality in this outcome is Good. This judgement has been made from evidence gathered both during and before the visit to the service. The home has an open culture, which enables residents to express their views and concerns in a safe and none blame environment. EVIDENCE: Residents who spoke to the inspector said they were listened to. Concerns can be raised either individually or at the meetings held weekly. This would be enhanced by the inclusion in records of action taken and feedback given. Residents spoke of being ‘ made to feel welcome’ and ‘feeling safe’. Information included in the pre inspection questionnaire indicated the home has policies and procedures in relation to the handling of complaints, whistle blowing and prevention of abuse. Staff have received training in relation to prevention of abuse as part of the NVQ qualifications. First Step DS0000000065.V305221.R01.S.doc Version 5.2 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 the following standard(s): 24 & 30 Quality in this outcome is Adequate. This judgement has been made from evidence gathered both during and before the visit to the service. The home provides a physical environment that meets the specific needs of the residents. The home is comfortable but would benefit from a rolling programme to improve the decoration, fixtures and fittings. EVIDENCE: Due to the short term occupancy of the residents and agreed restrictions bedrooms have limited personalisation. The home was found to be clean and comfortable. Work has been carried out in the garden areas improving the external appearance and giving a more pleasant area for residents to sit outsides the building. Some decoration has taken place internally, however some areas of the building and furniture provided are looking old and tired. The environment would benefit from a programme of refurbishment and decoration. First Step DS0000000065.V305221.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. Quality in this outcome is Good. This judgement has been made from evidence gathered both during and before the visit to the service. The service ensures that all staff within its organisation receive relevant training that is targeted and focussed on improving outcomes for residents. Staff receive supervision however this would benefit from further development. Staff recruitment is robust and promotes the protection of residents. EVIDENCE: During the inspection three staff files were examined. These were found to contain the appropriate documentation in relation to recruitment. The home has a policy on risk assessment following a Criminal Record Bureau disclosure. Information from staff files seen and the pre inspection questionnaire received from the home indicated staff have undertaken training in relation to First aid, Fire safety, Infection control, Acupuncture, Drug and Alcohol awareness, Crack awareness, and counselling. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 19 Four staff members (40 ) have achieved NVQ at level 2 or 3 and a further 6 staff are undertaking the training. Staff were able to demonstrate by response to questions a good understanding and knowledge of the residents and how their individual care needs are met. Staff receive informal supervision, formal supervision is being developed as to content and frequency. First Step DS0000000065.V305221.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, & 42. Quality in this outcome is Good. This judgement has been made from evidence gathered both during and before the visit to the service. The home is well managed, there is a positive atmosphere that promotes the independence, safety and well-being of the residents. Residents feel safe and are confident their views are heard. EVIDENCE: The manager is a first level nurse, who has experience and knowledge of management of the client group. She told the inspectors that she plans to commence a Masters degree in September this year. Residents and staff who spoke to the inspectors indicated the home was well run and they felt supported by the manager. The home has an open door policy where all can raise concerns and issues. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 21 Residents have limited input into the development of the home due to the timescales of the programmes of rehabilitation, however there are weekly residents meetings. The home submits Regulation 26 visit reports to the Commission for Social Care Inspection. However the regular meetings of the Quality Assurance group have not taken place recently. The manager told the inspector that this was to be addressed. Information contained in the pre inspection questionnaire indicated the home and equipment are maintained as required, and fire alarms are tested weekly. Other information indicated the home has a range of policies and procedures that should promote the safety and well being of residents. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 3 x First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 (2) Requirement The recording of controlled medication must be made more robust to provide a clear audit trail. Advice must be sought in relation to the administration of crushed medication. Timescale for action 01/10/06 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 3 4 Refer to Standard YA22 YA24 YA36 YA39 Good Practice Recommendations Records of residents weekly meeting would be enhanced by inclusion of actions taken and feedback given. The environment would benefit from a programme of refurbishment and decoration. Formal staff supervision should be developed in relation to content and frequency. Work should continue to develop the homes quality assurance. First Step DS0000000065.V305221.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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 First Step DS0000000065.V305221.R01.S.doc Version 5.2 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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