Inspection on 20/08/07 for First Step

This inspection was carried out on 20th August 2007.

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 2 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 01/08/06

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 20th August 2007 09:30 First Step DS0000000065.V348575.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.V348575.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.V348575.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.V348575.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2006 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 up to 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 £405.64 to £465.42 per week. First Step DS0000000065.V348575.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 to the home. During the visit, which lasted a total of four and a half hours the inspector carried out an audit of documentation including staff records and residents files, walked around the building, and spoke to one resident, two staff members, and the manager. Ten residents returned service user surveys to CSCI. What the service does well: What has improved since the last inspection? Refurbishment and decoration has continued to greatly improve the home giving a more relaxing and comfortable environment for the people who use the service. Records of controlled medication have been developed and now give a clear audit trail, however staff must ensure that these are completed with two signatures to confirm accuracy of administration and stock retention. The quality assurance systems used by the home are being developed to assess the quality of service given at each stage of the programme. First Step DS0000000065.V348575.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. First Step DS0000000065.V348575.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.V348575.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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standard 2 & 5 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective people to use the service have the information needed and have their needs assessed. Residents have a contract that clearly tells them about the service and the restrictions on their liberty and freedom of movement. EVIDENCE: During the inspection three 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 assessment was seen to include information regarding the persons mental and physical health, personal history and current circumstances. The inspector was told that the home considers the needs of individual residents and how these are to be met prior to any admission. First Step DS0000000065.V348575.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. Documentation in the files seen indicated that the regime and restrictions of the programmes are fully discussed with the prospective resident either prior to or on admission. The resident who spoke to the inspector and responses in the surveys returned to CSCI 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.V348575.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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standards 6, 7, & 9 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Whilst the nature of the programme places restrictions on people, individuals are involved in decisions about their lives and play an active role in planning the care and support they receive. EVIDENCE: During the inspection three resident files were examined. These were found to contain information with regard to the care plan for each stage of the programme of rehabilitation. Documentation seen included information in relation to the emotional and psychological support offered to individuals, as well as any relevant health care. First Step DS0000000065.V348575.R01.S.doc Version 5.2 Page 11 The risk assessment process is commenced prior to admission and continues throughout the rehabilitation programme which promotes and works towards independent living. Documentation was seen to be up to date and included evidence of regular review and evaluation that reflected goals set by individual residents. One file examined was for a resident completing the last stage of the programme. This was seen to include a relapse prevention plan. Daily recordings were seen to be current and included a number of entries per day. The home has connections with and access to outside organisations such as Alcoholics Anonymous. Comments received from residents included ‘ this has helped me a lot’ and ‘the staff have supported me’. First Step DS0000000065.V348575.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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standards 12, 13, 15, 16, & 17 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this 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. First Step DS0000000065.V348575.R01.S.doc Version 5.2 Page 13 As residents progress through the programme time away from the home unaccompanied is increased, giving access to the gym, community programmes etc. There is limited access to television and a computer. The resident who spoke to the inspector talked of attending a computer course. 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, including the planning and preparation of all the meals served at the home. Responses received by the inspector on the day of the inspection or within surveys returned to CSCI indicated that all restrictions are discussed with individuals and people were generally satisfied with the care and support given. First Step DS0000000065.V348575.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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standards 18, 19, & 20 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported and helped with both physical and emotional health care promoting their independence and well-being. EVIDENCE: The home provides a key worker system to offer residents support from a named individual. Responses received by the inspector indicated people were satisfied with the support they were given. One resident who spoke to the inspector said he felt supported by all the staff throughout the programme, especially his key worker during one to one sessions. Residents at the home have access to a local medical practice that offers specialised support during rehabilitation, as well as other health professional such as dentists and opticians. First Step DS0000000065.V348575.R01.S.doc Version 5.2 Page 15 The resident who spoke to the inspector said he had been helped by the staff to receive both dental and eye care. A number of residents who use the service have access to an outreach worker based within the home. Her role is to enable residents to obtain appropriate welfare benefits and gain assistance with housing if required after leaving the programme. An audit of medication was carried out. This identified no major concerns with ordering, storage and administration of medication. The home continues to complete medication administration records that include resident’s signatures as confirmation of administration of all medication. The recording of controlled medication has been developed and improved to give a clearer audit trail of medication received, stored and administered. However the controlled medication register did not always contain the signature of two staff for each entry. The record of medication returned to the pharmacy was not always signed by the person receiving the medication. The home has developed a policy and procedure in relation to the crushing of specified medication as required at the previous inspection. Information given to the inspector indicated staff who administer medication have either received training or are currently undertaking training in relation to safe handling of medication. First Step DS0000000065.V348575.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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standards 22 & 23 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a robust complaints procedure. EVIDENCE: 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. Responses in surveys received by CSCI indicated residents are made aware of the complaints procedure. Responses also indicated that issues and concerns were listened to. The resident who spoke to the inspector confirmed there are regular service user meetings as well as one to one sessions where any concerns can be raised. The home retains records of any complaints received, this was seen to include details of the complaint and response to the complainant. First Step DS0000000065.V348575.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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standards 24 & 30 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment. EVIDENCE: A programme of refurbishment and decoration has been carried out in the home greatly improving the environment in both individual bedrooms and communal areas. This includes the provision of new curtains or blinds to lounges, bedrooms and bathrooms, new bedding and some new carpets. The furniture in both lounges has been replaced, giving a more relaxing and comfortable environment for the residents. First Step DS0000000065.V348575.R01.S.doc Version 5.2 Page 18 New equipment has been purchased for the kitchen including microwave and cooker. Residents at the home continue to have the responsibility for the cooking of meals, domestic tasks and their own laundry. First Step DS0000000065.V348575.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standards 32, 34, 35, & 36 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained skilled and in sufficient numbers to support the people who use the service and to support the smooth running of the home. EVIDENCE: During the inspection the files of three staff members were examined. One of these was of a member of staff recently recruited. This was seen to contain the appropriate documentation, however the CRB disclosure had been received after the person commenced work. The manager told the inspector that due to changes in obtaining CRB disclosures there had been a delay in receiving this, however the person had been supervised until the disclosure was obtained. There was no evidence of a PoVA first check. The files of the other two staff each contained evidence of CRB obtained prior to their employment. The home has a policy on repeating the CRB check at regular intervals. First Step DS0000000065.V348575.R01.S.doc Version 5.2 Page 20 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. Information in the pre inspection questionnaire indicated 61.5 of staff have obtained their NVQ at level 2 or above and further staff were 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. A programme of staff supervision has been implemented. First Step DS0000000065.V348575.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standards 37, 39, & 42 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is based on openness and respect, and has quality assurance systems developed by a qualified and competent manager. 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 has recently completed her Masters degree. First Step DS0000000065.V348575.R01.S.doc Version 5.2 Page 22 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. Residents who responded either directly to the inspector or via a survey confirmed they were generally satisfied with the service they received. The staffing structure of the home has been altered and now includes a service coordinator who has the responsibility to monitor the quality of service provided. Residents have limited input into the development of the home due to the timescales of the programmes of rehabilitation. However there are regular residents meetings, and the quality assurance system has been developed to include the use of questionnaires every 2 months to ascertain the opinions of residents at different stages of the programme. Plans of care are audited on a regular basis. 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.V348575.R01.S.doc Version 5.2 Page 23 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 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 3 X X 3 x First Step DS0000000065.V348575.R01.S.doc Version 5.2 Page 24 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 ●All entries in the controlled medication register must contain the signature of two staff to confirm the accuracy of administration and stock retention. ●The record of medication returned to the pharmacy must contain the signature of the person receiving the medication. The registered person must ensure that a satisfactory PoVA first or CRB disclosure has been obtained prior to employment of staff. Timescale for action 01/10/07 2 YA34 19 01/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations First Step DS0000000065.V348575.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V348575.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!