Inspection on 25/10/05 for First Step

This inspection was carried out on 25th 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

First Step 03/07/09

First Step 20/08/07

First Step 01/08/06

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 Announced Inspection 25th October 2005 10:00 First Step DS0000000065.V261116.R01.S.doc Version 5.0 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.V261116.R01.S.doc Version 5.0 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.V261116.R01.S.doc Version 5.0 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.V261116.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 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. First Step DS0000000065.V261116.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During the announced inspection the inspector spoke to four residents, one staff member and the manager of the service. Documentation including staff records and residents care files were examined. A partial tour of the home took place. Comprehensive information was supplied by the managers prior to the inspection in the form of a pre inspection questionnaire, self-assessment audit and copies of other documentation. A total of 5 hours were spent at the home. What the service does well: What has improved since the last inspection? Staffing levels at the home have improved, promoting the opportunity for residents to go out into the community and participate in leisure activities. Key worker sessions are more consistent, residents commented on the benefit they receive from these. Adult protection policies have been developed to include information and contact numbers for the local Adult Protection team and Co-ordinator. First Step DS0000000065.V261116.R01.S.doc Version 5.0 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 DS0000000065.V261116.R01.S.doc Version 5.0 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.V261116.R01.S.doc Version 5.0 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 Robust assessment and admission procedures are in place that should ensure the residents are suitably placed and are enabled to make an informed choice of service. EVIDENCE: Three residents files were examined. These were found to contain evidence that the home carries out a comprehensive pre admission assessment, including input from all professionals involved in the care of the prospective resident. The manager told the inspector that residents are given information regarding the service prior to admission. All residents spoken to confirmed that they had been given the clients information booklet at their assessment and were made aware that the rehabilitation programme would curtail their unescorted liberty for at least six weeks as well as other restrictions to their freedom of choice. All confirmed that they had signed a licence agreement that included terms and conditions of the service. First Step DS0000000065.V261116.R01.S.doc Version 5.0 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 the following standard(s): 6&9 The home has taken action with regard to recruitment of staff that should ensure residents receive the full programme of rehabilitation. Risks are assessed and agreed with all involved. EVIDENCE: Three residents files examined each contained detailed information of their care programme, including records of key worker sessions and reviews. These reflected the changing needs, wellbeing, and goals of the individual resident. Residents spoke of the value of counselling sessions they have the opportunity to participate in. The home has recently employed three members of staff that should ensure that programmes of care and individual sessions can be met as required at the previous inspection. First Step DS0000000065.V261116.R01.S.doc Version 5.0 Page 10 The residents who spoke to the inspector confirmed that there had been an issue in the past with regard to limited staffing but this had now been addressed. The risk assessment process is commenced prior to admission and continues throughout the rehabilitation programme which promotes and works towards independent living. First Step DS0000000065.V261116.R01.S.doc Version 5.0 Page 11 Residents confirmed that programmes of rehabilitation and restrictions are discussed with them. One service user spoke of the support that they received from all staff especially the key worker with achieving the goals set out in the programme of rehabilitation. First Step DS0000000065.V261116.R01.S.doc Version 5.0 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): 16 Restrictions on resident’s rights and choices are discussed and agreed with individuals as an interregnal part of the rehabilitation programme. EVIDENCE: Due to the nature of the rehabilitation programme provided by the service, considerable restrictions are placed upon residents especially within the first six weeks. During this period residents can only go out into the community accompanied by a member of staff. Residents who spoke to the inspector told her that they had agreed and accepted the restrictions involved in their care. They felt that staff respected them as individuals. One resident told the inspector that staff always had time to discuss issues and give support. Programmes of care included details of rehabilitation and increasing individuals responsibilities in their daily lives. First Step DS0000000065.V261116.R01.S.doc Version 5.0 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 the following standard(s): 19 & 20 Residents physical and emotional health needs are met, promoting their wellbeing. Developments within the medication system must be implemented to promote the protection of the residents. EVIDENCE: As well as the general support of the staff the home provides a key worker system to offer residents support from a named individual. Residents who spoke to the inspector told her that they valued this individual time and sessions were generally taking place as planned. Resident’s plans of care include details of support given during their programme of rehabilitation, including counselling sessions. Residents confirmed that the staff supported them with their physical health care needs and they all had access to medical services as necessary. First Step DS0000000065.V261116.R01.S.doc Version 5.0 Page 14 An audit of medication found that there were no major concerns with ordering, storage and recording of medication. However hand written entries of information of medication to be administered on the Medication Administration Records did not always contain signature of people transferring and confirming information. It is recommended that each entry is signed by the person transferring the information and countersigned as confirmation of accuracy. On the day of the inspection the manager developed a medication chart that addressed this issue. The home has acquired an up to date BNF as required at the previous inspection. It was also found that the homes practice was to transfer a number of medications from the container supplied by the pharmacist into a weekly medication dispensing container. All medication must be administered from a container appropriately labelled with the persons name, medication name, dosage and administration instructions. The manager removed all the inappropriate containers on the day of the inspection. First Step DS0000000065.V261116.R01.S.doc Version 5.0 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 the following standard(s): 23 Policies and procedures are in place that promote the protection of vulnerable adults. EVIDENCE: Evidence was seen that showed the home has developed the policy in relation to protection of vulnerable adults from abuse to include details of the ‘ no secrets’ guidance and contact numbers for the Adult Protection team as required at the previous inspection. The home also has a policy and procedure in relation to whistle blowing. First Step DS0000000065.V261116.R01.S.doc Version 5.0 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 the following standard(s): 24 & 30 The home provides a comfortable environment that is appropriate for purpose. EVIDENCE: Due to the short term occupancy of the residents and agreed restrictions bedrooms were found to contain minimal personal items. A number of residents are accommodated in small self-contained units, which provide bedroom, living area and en suite bathroom. The home provides two lounges and dining facilities. The manager of the home told the inspector that decoration and repairs are carried out as identified. As part of the rehabilitation programme residents are responsible for the cleanliness of their own rooms and the home. On the day of the inspection the home was found to be clean, tidy and comfortable. First Step DS0000000065.V261116.R01.S.doc Version 5.0 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 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 The homes recruitment procedure is robust and promotes the protection of residents. Staff employed at the home are receiving appropriate training to enhance the care and rehabilitation of the residents. On going training is taking place with regard to NVQ qualifications. EVIDENCE: Three staff files of recently recruited staff were examined. These were found to contain all the appropriate information with regard to recruitment and induction. The home has policies and procedures in relation to recruitment and selection, including Criminal Record Declaration. Pre inspection information contained details of training undertaken by staff. This indicated that 42 of the staff have achieved NVQ level 2 and a further four staff are currently working towards the qualification. Staff have also completed fire safety training and first aid. A number of staff have also completed safe handling of medication, infection control, drug awareness and acupuncture. First Step DS0000000065.V261116.R01.S.doc Version 5.0 Page 18 The manager told the inspector that staff are to undertake further training in drug awareness, alcohol awareness, prescription poly drug use and crack training in the near future. First Step DS0000000065.V261116.R01.S.doc Version 5.0 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 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): 39 Residents are given the opportunity to voice their views and participate in the quality assurance plan. EVIDENCE: Residents and staff who spoke to the inspector told her the home was well run, the manager was supportive and had an open door policy. Team meetings and daily house meetings for residents enable people the opportunity to voice their views and opinions, however input into development of the home is limited due to the timescales of the programmes of rehabilitation. The home has a quality assurance plan that includes monthly consultation groups and committee representative meetings. First Step DS0000000065.V261116.R01.S.doc Version 5.0 Page 20 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 X 3 X X 3 Standard No 22 23 Score x 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X x 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 x 17 Standard No 31 32 33 34 35 36 Score X 2 X 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 First Step Score X 3 2 x Standard No 37 38 39 40 41 42 43 Score X X 3 X X X x DS0000000065.V261116.R01.S.doc Version 5.0 Page 21 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 20 Regulation 13 Requirement The home most administer medication from appropriately labelled containers supplied by the pharmacist. Timescale for action 25/10/05 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. Refer to Standard 20 Good Practice Recommendations It is recommended that each hand written entry on medication administration charts are signed by the person transferring the information and countersigned as confirmation of accuracy. 50 of care staff should hold their National Vocational Qualification level 2 or above in care by 31st December 2005. 2. 32 First Step DS0000000065.V261116.R01.S.doc Version 5.0 Page 22 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.V261116.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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