Inspection on 17/05/05 for First Step

This inspection was carried out on 17th May 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 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.

Other inspections for this house

First Step 03/07/09

First Step 20/08/07

First Step 01/08/06

First Step 25/10/05

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 Penni Hughf Unannounced 17 May 2005 09:30 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. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service First Step Address 114 Marton Road Middlesbrough TS1 2DY 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) 01642 231476 01642 232239 Endeavour Housing Association Mrs Gail Starling Care Home 15 Category(ies) of D - Drug dependence past/present registration, with number A - Alcohol dependence past/present of places First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2004 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. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took seven and three quarter hours and was carried out as one of the two statutory annual inspections required by the Care Standards Act 2000. A partial tour of the premises took place and staff, care and maintenance records were inspected. Two staff on duty were interviewed, together with six of the fifteen residents. There were no visitors during the inspection. What the service does well: What has improved since the last inspection? The home has made sure that the contact numbers for adult protection are included in the protection procedure. The home has developed the client information booklet to give a clear list of what items are not to be brought into First Step and what items are acceptable. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 6 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. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 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 First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 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 Robust assessment and admission procedures are in place that ensure prospective residents are able to make an informed choice. EVIDENCE: The homes’ Statement of Purpose and client information booklet, contained all the elements required by the Care Standards Act 2000 and detailed aspects of life in the home, including the four stage rehabilitation programme, that gave prospective service users the opportunity to make an informed choice about their decision to move in. It was reviewed annually and was due for review again in July 2005. All the residents spoken to confirmed that they had been given the clients information booklet at their assessment and were aware from both this and the manager, that the rehabilitation programme would curtail their unescorted liberty for at least the first six weeks of the programme. The client information booklet had just been updated, to include a list at the front of items to bring and items not to bring with them on admission. This included some household products that were alcohol based. Three files examined contained a section on pre-admission assessment, which included medical and social information, together with a risk assessment and factual details. It was discussed that the form could be developed to include what the resident hoped to get out of their stay, although it was acknowledged that for all the residents spoken to, it was simply to be ‘clean’ or ‘dry’. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 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 & 8 The home must ensure that recruitment, retention and communication are addressed to ensure residents receive the service upon which they made the choice to come to First Step. EVIDENCE: All three resident’s files examined contained a care plan, which detailed dates, times and content of key worker sessions. However, of the three care plans, only one held up to date records of one to one key worker sessions. Staff need to ensure that the sheets contain the residents’ name and/or number, and that the date is included. (All resident’s records were issued with a number for confidentiality purposes.) Care plans were reviewed regularly and clearly reflected residents changing needs and goals. The rehabilitation programme included a weekly clearance group, where issues between residents were discussed and addressed and a weekly residents group for other issues. In addition, the manager held a monthly resident’s group and one to one key worker sessions took place on a regular basis. The manager, staff and residents all agreed that this was part of the programme. However, it was also acknowledged by all parties that recently, there had been some disruption to some of these groups and one to one sessions. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 10 Discussion with the manager, and examination of records, highlighted that problems with staff recruitment and retention had led to difficulties in ensuring that all sessions took place as programmed. This clearly left a gap at times between proposals and practice. Residents interviewed said that they did not always receive feedback after residents meetings and therefore did not feel their views were always taken into account. Each week, group sessions were held on relapse prevention and personal development, and life skills. Residents agreed that these compulsory sessions always took place. Feedback to the manager regarding the residents’ dissatisfaction with the issues related above, resulted in a meeting being planned for the following day with the residents. The inspector received minutes of that meeting on the 18th May 2005 First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 11 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) 11,12,13,14,15 & 17 Staff shortages are limiting leisure activity opportunities for the residents. Appropriate opportunities exist to enable residents to develop independent living skills EVIDENCE: The rehabilitation programme provided by the establishment, by it’s very nature, places considerable restrictions upon residents during their first six weeks of occupancy. During this period residents can only go out into the community, if accompanied by staff. Once again, staffing issues have resulted in some planned community visits being cancelled, which reduced that opportunity for residents to participate in activities and they said this left them with more time than they would like to focus on their situation. The manager had taken every step possible to ensure that these visits went ahead as planned until extra staff could be recruited. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 12 One of the mainstays of the residents’ week was their visits to the JJB gym, located within walking distance of the establishment. Unfortunately, these had ceased two weeks prior to the inspection visit, due to the withdrawal by the gym of First Steps open membership. (This had enabled unnamed residents to use the passes.) The gym’s new policy was to only allow named membership, at a cost which was not affordable for residents. Residents voiced their disapproval of this saying that First Step was not making sufficient effort to find an alternative venue. Discussing this with the manager, she said that consideration was being given to two other local gyms, but recognised this was a big issue for the residents. Minutes of the meeting held the following day as a result of the inspection findings, stated that agreement had been reached by manager and residents for the manager and two residents to visit the residents preferred option on the 18 May. The life skills programme, which was compulsory, provided regular opportunity for the development of practical skills, including budgeting and housekeeping. An outreach worker provided support to residents in the latter stages of their stay, helping to find appropriate accommodation. This included looking at needs and expectations, giving residents a practical understanding of the geography of the various accommodations (how far from town) and supporting access to housing associations, local authorities, sheltered housing etc. All meals at First Step were prepared by the residents on a rotational basis, again as part of their preparation for returning to independent living in the outside community. Residents said that the food was good and in sufficient quantity. All activities offered were age, peer and culturally appropriate, within the bounds of the programme (e.g. unable to visit the pub for a night out.) Visits by family and friends were allowed within the confines of the programme and residents spoken to who were still on their six week stop in, said that they were able to have telephone calls with family. In stage 2, visits were allowed by family and close friends at weekends and a progressive programme of family contact continued through stages 3 and 4. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 13 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 & 20 Robust procedures are in place for the management of medication that protect residents. Due to staffing levels, there is a lack of consistency in the provision of key worker support. EVIDENCE: The home provided a key worker system to offer residents support from a specific individual, in addition to general staff support. Some of those residents spoken to during the inspection said that these support sessions over the past few weeks had not always matched up with the timetable in the hallway, which suggested two key worker sessions a day. The manager said that the timetable identified times in the programme when key worker sessions could take place, but this did not mean that all residents would be able to see their key worker at that time. She acknowledged that the timetable could be misread and said that she would address the problem. Care plans examined identified that key worker sessions did take place, although staff must ensure that these are written up in a timely manner. One resident spoken to during the inspection suggested that 2 key worker sessions a week, or one longer session, would be beneficial. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 14 Comprehensive policies and procedures were in place covering all aspects of dealing with medication, it’s transfer to and from the Pharmacy, and the disposal of illegal substances found in the home. The home held a BNF but this was dated September 2003. This should be replaced with a 2005 edition to ensure the establishment has up to date information. A returns book was kept at the home, and the pharmacist held a copy of the returns. Six staff had successfully completed a ‘safe handling of medicines’ course. All residents admitted for drug dependency were under the care of the same GP. This was due to the specialist nature of their needs and his knowledge as a specialist practitioner in this area. All residents admitted for alcohol dependency completed a GP form, which was sent to James Cook House, who then allocated them a GP in the local vicinity. MAR sheets were held in a ringbinder, with clear procedures for administration printed on the front. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 15 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 Staff display a knowledge and understanding of Adult Protection issues, which protects the residents from abuse. EVIDENCE: A comprehensive complaints procedure was in place, and was included in the clients’ information booklet that was given to all prospective residents, as well as being displayed on the residents’ notice board. Staff interviewed identified group and individual work, monitoring and observation as key areas in identifying and safeguarding against abuse. They said that any allegation of abuse would be taken immediately to the manager, or the on call senior. The point of contact with social services, for both day time and out of hours referrals, was now clearly identified in the policy: however, the policy must be developed to show a clear procedure that is linked to the Department of Health’s guidance, “No Secrets.” Residents interviewed said that they felt their complaints and concerns would be listened to. They said that they felt safe at First Step. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 16 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) Standards not inspected on this occasion. EVIDENCE: Although these standards were not inspected on this occasion, residents interviewed did make comment to say that their accommodation was good – one resident stating that his room was “brilliant.” First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 17 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) 31,43 & 35 Robust recruitment procedures are in place and staff training programmes ongoing and appropriate, however problems with retention of staff are limiting access to some activities. EVIDENCE: Two members of staff held their National Vocational Qualification level 2 in care, with a further five staff currently undertaking it. One member of staff had successfully completed her National Vocational Qualification level three. Six staff had undertaken a three day ‘Motivational Interviewing’ Course and four staff had completed a ‘Drug Awareness’ Course, three at level one and one at level two. Six staff had completed a twelve week ‘Safe Handling of Medicines’ Course. Staff interviewed said that they were encouraged to undertake training courses and felt supported by the manager. A course on ‘Professional Boundaries’ was booked to take place on 23rd June 2005. Staff roles were clearly delineated, with project workers and outreach workers having different responsibilities. The manager highlighted difficulties in recruitment, and the retention of staff that were qualified, and said that these issues had been raised at committee meetings. Arrangements were in place undertaking some work around looking at why people had left over the past five years. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 18 The manager said that when staffing levels fell below the standard level, resident’s access to the community was affected, and staff and residents all confirmed this. In addition, the manager was faced with the problem of losing her experienced and qualified staff and mostly only being able to replace them with unqualified staff. Nevertheless, robust recruitment procedures were in place, with Criminal Records Bureau checks and references available for inspection. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 19 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) 37,38 & 42 The manager/provider has a clear development plan for the home and staff are well supported and confident in the leadership provided. Residents’ health and safety is protected by structured maintenance schedules. EVIDENCE: The manager was a qualified Registered Mental Nurse, with a Diploma in teaching and counselling and some administrative procedures. In June 2003, she successfully completed the Registered Managers Award. Staff said that the manager was always contactable, had an open door policy and was always supportive. Strategies for enabling staff and residents to voice their views and opinions included team meeetings for staff and house meetings for residents. Residents and staff spoken to said that the home was well run. The only concerns raised were regarding limitations at times caused by staffing issues. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 20 A quality assurance group, which consisted of members from the management committee, the staff, current residents and ex residents, took place monthly. Again, staffing issues had affected this, with the last two months meetings having been cancelled. A meeting had been arranged for 13 June. Training and maintenance records were evidenced and included fire training, emergency lighting tests, clinical waste contract, gas maintenance, fire extinguishers and portable appliance tests. First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 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 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 2 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 3 2 2 3 3 x 3 Standard No 31 32 33 34 35 36 Score x x x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 First Step Score 2 x 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x 3 x B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 22 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 YA6 Regulation 18 Requirement Staff must be employed in sufficient number to provide all elements of the rehabilation programme Opportunities for residents to use the community accompanied by staff, must not be limited due to staff shortages. The homes adult protection procedure must be developed to include reference to the Dept. of Healths guidance No Secrets Timescale for action 01/08/05 2. YA13 12 17/05/05 3. YA23 13 01/07/05 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. 3. 4. Refer to Standard YA6 YA8 YA20 YA32 Good Practice Recommendations Records of one to one keyworker sessions should contain dates and signatures, together with residents name and/or number. Residents should received feedback about the outcomes of their comments at residents meetings A new BNF book should be obtained to replace the existing one dated 2003 50 of care staff should hold their National Vocational Qualification level 2 in care by 2005 B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 23 First Step First Step B51-B01 S65 First Step V227571 170505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Unit B, 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. 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